Telephonic Case Manager

Sedgwick • Dayton, OH • 3w ago

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to Work®

Most Loved Workplace®

Forbes Best-in-State Employer

Telephonic Case Manager

PRIMARY PURPOSE : To perform initial and ongoing clinical assessment and evaluate need for alternative treatment, to negotiate and coordinate appropriate medical treatment and length of disability with providers and employers; and to implement a case management plan with ongoing monitoring to ensure quality and appropriate service delivery of the case management process.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Performs initial and ongoing clinical assessment via telephone calls to client (injured employee), employer, physician and attorney as indicated; assesses client's situation for psychosocial needs, cultural implications and support systems in place.

Creates a case management plan based on the assessment with measurable goals and objectives utilizing evidence-based criteria; monitors ongoing progress toward these goals and objectives; implements plan through case management interventions and communication with all parties to reach desired goals and objectives.

Evaluates need for alternative treatment.

Negotiates appropriate level and intensity of care and disability duration with providers through use of medical and disability duration guidelines, adhering to quality assurance standards.

Negotiates and coordinates a prompt return to work with employer.

Measures interventions to determine the outcome of the case manager's involvement to include clinical, financial, variance, quality of life, and client satisfaction; maintains accurate record of management including costs, savings and demographic data.

Provides case direction and supervision to field case specialists when on-site intervention is required; ensures quality and appropriate service delivery.

Communicates effectively with handling claims examiner, client, claimant, attorney and supervisor.

Maintains client's privacy and confidentiality, promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

Performs other duties as assigned.

Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing

Current unrestricted RN license(s) in a state or territory of the United States required. Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred. Certification in case management, rehabilitation nursing or a related specialty is highly preferred.

Experience

Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years of fulltime equivalent providing direct clinical care to the consumer.

Skills & Knowledge

Knowledge of workers' compensation laws and regulations

Excellent oral and written communication, including presentation skills

PC literate, including Microsoft Office products

Leadership/management/motivational skills

Analytical and interpretive skills

Strong organizational skills

Excellent interpersonal skills

Excellent negotiation skills

Ability to work in a team environment

Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

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