- 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.
- 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)
- Oral and written communication, including presentation skills
- PC literate, including Microsoft Office products
- Analytical and interpretive skills
- Strong organizational skills
- Excellent interpersonal skills
- Ability to work in a team environment
- Ability to meet or exceed Performance Competencies
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Disability Clinical Specialists - Dubuque, United States - Sedgwick
Description
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
Disability Clinical Specialists
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
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
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
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.
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.
