Case Management Specialist - RN Job Opening at Sedgwick Claims Management Services, Inc in Rochester, NY

PRIMARY PURPOSE: To perform initial and ongoing clinical assessment and evaluate need for alternative treatment; to negotiate and coordinate appropriate medical treatment and length of disability with providers and employers; and to implement a case management plan with ongoing monitoring to ensure quality and appropriate service delivery of the case management process.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

1. Performs initial and ongoing clinical assessment via telephone calls to client (injured employee), employer, physician and attorney as indicated; assessment of client's situation will include psychosocial needs, cultural implications and support systems in place.
2. Creates a case management plan based on the assessment with measurable goals and objectives utilizing evidenced-based criteria; monitors ongoing progress toward these goals and objectives; implements plan through case management interventions and communication with all parties to reach desired goals and objectives.
3. Evaluates need for alternative treatment.
4. Negotiates appropriate level and intensity of care and disability duration with providers through use of medical and disability duration guidelines, adhering to quality assurance standards.
5. Negotiates and coordinates a prompt return-to-work with employer.
6. Measures interventions to determine the outcomes of the case manager's involvement to include clinical, financial, variance, quality of life, and client satisfaction; maintains accurate record of management including costs, savings and demographic data.
7. Provides case direction and supervision to field case specialists when on-site intervention is required; ensures quality and appropriate service delivery.
8. Communicates effectively with handling claims examiner, client, claimant, attorney and supervisor.
9. Maintains client's privacy and confidentiality; promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

1. Performs other duties as assigned.
2. Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing
Active RN license(s) required. Baccalaureate 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.

Experience
Two (2) years of full-time equivalent of direct clinical care to the consumer required.

Skills & Knowledge

• Knowledge of workers compensation laws and regulations
• Excellent oral and written communication, 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
• Ability to meet or exceed Performance Competencies

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

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 CMS is an Equal Opportunity Employer

and a

Drug-Free Workplace