RN Medicare Compliance-Proactive Reduction Outreach

Sedgwick • Augusta, ME • 3h ago

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

RN Medicare Compliance-Proactive Reduction Outreach

PRIMARY PURPOSE : To perform initial and ongoing clinical assessment through provider outreach, specialized document review, and analysis and interpretation of interventions for the preparation of Medicare Set-Aside allocations.

ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Contacts providers and attorneys to obtain clarification of documentation needed to support the preparation of Medicare Set-Aside allocations.

Uses specialized knowledge to assess the needs of the individual case and creates customized correspondence for any applicable providers that will provide the clarity needed to proceed with the preparation of the Medicare Set-Aside.

Proactively and strategically plans and executes outreach activities with providers for each case via telephone, email, and fax, adhering to best practice guidelines.

Reviews and analyzes completed documentation from providers to ensure accuracy, completeness, adherence to quality assurance standards.

Measures interventions to determine the outcome of the clinical assessment involvement to include efficacy of response, financial, and client satisfaction; maintains accurate record of management including costs, savings.

Articulates and effectively documents clear and concise information with handling planner, specialist, client, and supervisor while maintaining client's privacy and confidentiality; adheres to ethical, legal, accreditation and regulatory standards.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

Performs other duties as assigned.

QUALIFICATIONS

Education & Licensing

Bachelor's degree from an accredited college or university preferred. Active unrestricted RN license issued in a state or territory of the United States required.

Experience

Four (4) years of related experience or equivalent combination of education and experience required.

Skills & Knowledge

Excellent oral and written communication skills, including presentation skills

PC literate, including Microsoft Office products

Analytical and interpretive skills

Strong organizational skills

Ability to create and complete comprehensive, accurate and constructive written reports

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.

TAKING CARE OF YOU BY

We offer a diverse and comprehensive benefits package including:

Three Medical, and two dental plans to choose from.

Tuition reimbursement eligible.

401K plan that matches 50% on every $ you put in up to the first 6% you save.

4 weeks PTO your first full year.

NEXT STEPS

If your application is selected to advance to the next round, a recruiter will be in touch.

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $60,000 - $65,000/year. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

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.

Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com

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