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Telephonic Case Manager

Role overview

Qualifications

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

Responsibilities

  • Performs initial and ongoing clinical assessment via telephone calls to evaluate the injured worker's injury and medical treatment
  • Effectively communicates and builds relationships with the claims’ examiner, client, injured worker, attorney and supervisor
  • Identifies issues related to delayed recovery and/or return to work and problem solves with a creative thinking approach
  • Negotiates treatment and disability duration with providers through use of medical and disability duration guidelines

Key facts

Other skills

  • Communication
  • Advocacy
  • Problem Solving
  • Creative Thinking
  • Negotiation
  • Ethical Standards And Conduct
  • Collaboration
  • Analytical Thinking
  • Time Management
  • Stress Management

About the company

EFI Global logo

EFI Global

Engineering Services

Over the last four decades, we have grown from a boutique firm specializing in handling insurance fraud and arson cases and providing expert witness testimony, to becoming a recognized leader in engineering failure analysis, origin and cause investigations, environmental consulting, laboratory testing and specialty consulting. Each member of our multi-disciplinary team of more than 700 professional engineers, fire investigators, architects and scientists was selected for his or her technical proficiency, in-depth industry knowledge and commitment to professional integrity. Together, our diverse backgrounds and collective insights empower clients to make better-informed business decisions. This expertise, coupled with the extensive coverage of more than 62 national offices plus offices in Canada, the United Kingdom and Brazil to provide global work abroad capability, has earned us a reputation for delivering timely responses that consistently meets our clients’ expectations — anytime, anywhere. EFI Global currently provides engineering services in the state of North Carolina by our partner firm, EFI Global of North Carolina, P.C. We also provide engineering services in the states of New York and New Jersey by our partner firm, EFI Global Engineering of New York, P.C. EFI Global is part of the Sedgwick family of companies, a global leader in the independent insurance claims industry.

Company details

Company typeSME
IndustryEngineering Services
Company size501 - 1000

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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

Telephonic Case Manager

This position is a remote position, however; you will be required to go into the Newport News, VA office from time to time. You must live in this area in order to be considered.

PRIMARY PURPOSE OF THE ROLE: While partnering with the injured worker, employer, and medical providers, create a case management strategy to facilitate medical recovery and a successful return to work through advocacy, communication and coordination of medical services.

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

  • Apply your medical/clinical or rehabilitation knowledge and experience to assist in the management of complex medical conditions, treatment planning and recovery from illness or injury.
  • Work in the best of both worlds - a rewarding career making an impact on the health and lives of others, and a remote work environment.
  • Enjoy flexibility and autonomy in your daily work, your location, and your career path while advocating for the most effective and efficient medical treatment for injured employees in a non-traditional setting. 
  • Enable our Caring counts® mission supporting injured employees from some of the world’s best brands and organizations. 
  • Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. 
  • Celebrate your career achievements and each other through professional development opportunities, continuing education credits, team building initiatives and more. 
  • Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. 

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

  • Performs initial and ongoing clinical assessment via telephone calls to evaluate the injured worker's injury, medical treatment, psychosocial needs, cultural implications and support systems.
  • Effectively communicates and builds relationships with the claims’ examiner, client, injured worker, attorney and supervisor.
  • Identifies issues related to delayed recovery and/or return to work and problem solves with a creative thinking approach
  • Negotiates treatment and disability duration with providers through use of medical and disability duration guidelines, adhering to quality.
  • Identifies opportunities to expedite care for cost containment and timely medical recovery.
  • Provides recommendations for alternate clinical resources to support claim resolution.
  • Maintains client's privacy and confidentiality, promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards.

EDUCATION AND 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.

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.

Auditory/Visual: Hearing, vision and talking 

TAKING CARE OF YOU BY

  • Offering a blended work environment.
  • Supporting meaningful work that promotes critical thinking and problem solving.
  • Providing on-going learning and professional growth opportunities.
  • Promoting a strong team environment and a culture of support.
  • Recognizing your successes and celebrating your achievements.
  • Thrives when everyone is working towards the same vision/goals.
  • We offer a diverse and comprehensive benefits package including:
  • Three medical, and two dental & vision plans to choose from.
  • Tuition reimbursement
  • 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.

#nurse #telephoniccasemanager

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 $73,000 - $75,000.  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.

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.

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Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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