Offer summary

Qualifications:

Bachelor's degree or equivalent preferred, with RN, LVN, CRC, COHN CVD, LPC, or LCSW preferred., Four years of related experience in a medical/psychological setting or physical industrial medicine, with previous insurance experience., Knowledge of current medical practices in various healthcare areas, including orthopedics and mental health., Strong organizational, analytical, and interpersonal skills, with proficiency in Microsoft Office..

Key responsibilities:

Perform clinical reviews of referred claims and document decision rationale.

Provide follow-up recommendations for ongoing medical management of claims and ensure appropriate recommendations are made.

Make timely contact with employees and/or providers to discuss clinical status and work status.

Act as a clinical resource to colleagues and achieve quality audit scores consistently.

Job description

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

Disability Clinical Specialist

PRIMARY PURPOSE: To perform clinical evaluations, consult providers and employees; to provide case direction; and to ensure medical information substantiates the need for absence from work.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Performs clinical review of referred claims; documents decision rationale; and completes medical review of all claims to ensure information substantiates disability.
Provides clear and appropriate follow-up recommendations for ongoing medical management of claims; ensures appropriate recommendations are made on claims.
Makes timely, appropriate contact with employee and/or providers to discuss employee’s clinical status, progress and work status.
Achieves appropriate quality audit scores on a consistent basis.
Acts as clinical resource to colleagues within the program.

QUALIFICATIONS

Education & Licensing

Bachelor's degree or equivalent preferred. RN, LVN, CRC, COHN CVD, LPC and/or LCSW preferred. Current license, registration and/or professional designations as required within the jurisdiction. Clinical expertise must be kept current by acquisition of the necessary CEUs to maintain licenses and designations.

Experience

Four (4) years of related experience or equivalent combination of education and experience required to include experience in a direct medical/psychological setting or physical industrial medicine and previous insurance experience.

Skills & Knowledge

Performs other duties as assigned.
Supports the organization's quality program(s).
Travels as required.
Knowledge of current medical practices in health care management in a variety of areas (including, but not limited to, orthopedics, general medicine for acute and chronic conditions, general surgery, mental health, obstetrics, oncology, and physical and occupational rehabilitation)
Ability to meet or exceed Performance Competencies
Ability to work in a team environment
Excellent interpersonal skills
Strong organizational skills
Analytical and interpretive skills
PC literate, including Microsoft Office products
Oral and written communication, including presentation skills

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

NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.

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.