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Sedgwick Disability Clinical Specialist in Springfield, Massachusetts

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Disability Clinical Specialist

IF YOU CARE, THERE’S A PLACE FOR YOU HERE

For a career path that is both challenging and rewarding, join Sedgwick’s talented team of 27,000 colleagues around the globe. Sedgwick is a leading provider of technology-enabled risk, benefits and integrated business solutions. Taking care of people is at the heart of everything we do. Millions of people and organizations count on Sedgwick each year to take care of their needs when they face a major life event or something unexpected happens. Whether they have a workplace injury, suffer property or financial loss or damage from a natural or manmade disaster, are involved in an auto or other type of accident, or need time away from work for the birth of a child or another medical situation, we are here to provide compassionate care and expert guidance. Our clients depend on our talented colleagues to take care of their most valuable assets—their employees, their customers and their property. At Sedgwick, caring counts®. Join our team of creative and caring people of all backgrounds, and help us make a difference in the lives of others.

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.

  • Performs other duties as assigned.

  • Supports the organization's quality program(s).

  • Travels as required.

  • 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

  • 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)

QUALIFICATIONS

Education & Licensing

  • Bachelor's degree or equivalent preferred.

  • RN or CRC 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.

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.

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