Medical Claims Case Manager I -Triage - Delta

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CLAIM YOUR FUTURE AS A GREAT PERFORMER!




Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been recently voted the Best TPA in America and the first and only Third Party Administrator to receive the coveted Employer of Choice® designation. Come be a part of our team and "Claim Your Future."


PRIMARY PURPOSE: To perform initial evaluation assessments and evaluate need for alternative treatment; to negotiate claims with providers and employers; and to provide case direction and supervision to field case specialists when on-site intervention is required ensuring quality and appropriate service delivery.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:Performs initial evaluation assessment via telephone calls to client, employer, and physician Evaluates need for alternative treatment Negotiates level of care, intensity and disability duration with providers Negotiates and coordinates a prompt return to work with employer Maintains accurate record of management including costs, savings and demographic data Adheres to quality assurance standards 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, and supervisor Maintains a quality assurance program to support the Total Performance Management initiative and the consistent delivery of quality claims service
REQUIREMENTS
Education & Licensing:Baccalaureate degree from an accredited college or university with degree in social work or vocational counseling or RN with active nursing license preferred Certification in rehabilitation nursing or a related specialist preferred


Experience: Two (2) years of clinical experience required




Skills & Knowledge:Knowledge of workers compensation laws and regulations Excellent oral and written communication skills, 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

Sedgwick CMS is an Equal Opportunity Employer