Company Detail

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Return-to-Work Specialist

PRIMARY PURPOSE : To negotiate, facilitate and monitor successful return to work of claimants within appropriate disability duration guidelines; to determine specific physical tolerances and vocational skills required for specific employment positions as requested by referral sources or employers; to assist case management staff with client competence decisions for individual positions; to contact employers to gather specific job site/employment information and prepare related reports documenting results; to assist with job site modification and/or obtaining adaptive equipment necessary; and to ensure medical, legal and accreditation standards are maintained.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Determines objective, quantifiable, medically supported work restrictions for assigned claims.

• Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and claimant; completes all vocational/RTW related jurisdictional or client directed documentation, notification or reporting; documents client contact in claim notes as per Sedgwick CMS standards; and assists case management staff in making decisions regarding client's competence for specific position.

• Adheres to medical and legal regulations and accreditation standards in written communication.

• Develops contacts with company managers to introduce program; represents client.

• Contacts employers to determine specific information regarding employment area (i.e. training/education needed, physical demands, wages and benefits, availability, etc); ascertains the specific physical tolerances and vocational skills needed for specific employment positions as requested by referral sources or employers; assists in modifying job sites or obtaining necessary adaptive equipment as needed; and communicates with co-workers regarding specific employment areas to apprise them of labor trends.

• Maintains regular contact with clients following placement, as per program guidelines; contacts involved individuals regarding progress on each case and makes suggestions as needed for changing rehabilitation plans.

• Works closely with team members to ensure smooth transition from medical case management into job placement.

• Prepares reports to document research results.

• Performs other tasks related to vocational evaluation and work adjustment training as needed.

• Performs other duties as assigned.

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

• Good working knowledge of return-to work or job accommodation procedures

• Good technical knowledge of claims management procedures

• Excellent oral and written communications, including presentation skills

• PC literate, including Microsoft Office products

• 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 talkingThe 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.

• QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university. Certified Rehabilitation Counselor (CRC), Certified Disability Management Specialist (CDMS), or Certified Case Manager (CCM) designation preferred. Experience Four (4) years of related experience or equivalent combination of education and experience required, including one (1) year of return-to-work or job accommodation experience OR four (4) years of claims management experience.

• #CRC #CDMS #CCM

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 $60,000-$65,000. 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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Disability Clinical Specialist

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.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

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

• Travels as required.

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

• 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

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.

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Return-to-Work Specialist

PRIMARY PURPOSE : To negotiate, facilitate and monitor successful return to work of claimants within appropriate disability duration guidelines; to determine specific physical tolerances and vocational skills required for specific employment positions as requested by referral sources or employers; to assist case management staff with client competence decisions for individual positions; to contact employers to gather specific job site/employment information and prepare related reports documenting results; to assist with job site modification and/or obtaining adaptive equipment necessary; and to ensure medical, legal and accreditation standards are maintained.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Determines objective, quantifiable, medically supported work restrictions for assigned claims.

• Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and claimant; completes all vocational/RTW related jurisdictional or client directed documentation, notification or reporting; documents client contact in claim notes as per Sedgwick CMS standards; and assists case management staff in making decisions regarding client's competence for specific position.

• Adheres to medical and legal regulations and accreditation standards in written communication.

• Develops contacts with company managers to introduce program; represents client.

• Contacts employers to determine specific information regarding employment area (i.e. training/education needed, physical demands, wages and benefits, availability, etc); ascertains the specific physical tolerances and vocational skills needed for specific employment positions as requested by referral sources or employers; assists in modifying job sites or obtaining necessary adaptive equipment as needed; and communicates with co-workers regarding specific employment areas to apprise them of labor trends.

• Maintains regular contact with clients following placement, as per program guidelines; contacts involved individuals regarding progress on each case and makes suggestions as needed for changing rehabilitation plans.

• Works closely with team members to ensure smooth transition from medical case management into job placement.

• Prepares reports to document research results.

• Performs other tasks related to vocational evaluation and work adjustment training as needed.

• Performs other duties as assigned.

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

• Good working knowledge of return-to work or job accommodation procedures

• Good technical knowledge of claims management procedures

• Excellent oral and written communications, including presentation skills

• PC literate, including Microsoft Office products

• 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 talkingThe 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.

• QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university. Certified Rehabilitation Counselor (CRC), Certified Disability Management Specialist (CDMS), or Certified Case Manager (CCM) designation preferred. Experience Four (4) years of related experience or equivalent combination of education and experience required, including one (1) year of return-to-work or job accommodation experience OR four (4) years of claims management experience.

• #CRC #CDMS #CCM

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 $60,000-$65,000. 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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

RN Bill Review

PRIMARY PURPOSE : To review hospital and professional medical bills from providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Applies clinical editing.

• Reviews operative reports to determine if surgery services were appropriately billed.

• Reviews complex medical, legal and consult services.

• Contacts client or facility to obtain additional or missing information.

• Handles provider appeals as appropriate to fee schedule and contractual disputes.

• Identifies and effects reductions on selected medical bills that are determined to include inappropriate, unrelated or undocumented charges within state specific workers' compensation laws rules and regulations.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

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

• Travel as required.

Education & Licensing

Bachelor's degree from an accredited college or university preferred. RN license required.

Experience

Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years workers' compensation/bill review experience in multi-state jurisdiction; prior experience in PPO provider appeals, re-pricing, surgery review, by report and RNE review; two (2) years of experience with complex medical, legal and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review.

Skills & Knowledge

• Extensive knowledge of re-pricing rules and guidelines

• Knowledge of medical terminology, anatomy and surgical terminology

• Knowledge of CPT/ICD9

• PC literate, including Microsoft Office products

• High level of accuracy and attention to detail

• Ability to multi task and function in high volume area

• Problem solving skills and ability to handle deadlines

• 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.

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 $70,000-$72.000 . 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.

Always accepting applications.

#RN #billreview

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

RN Bill Review

PRIMARY PURPOSE : To review hospital and professional medical bills from providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Applies clinical editing.

• Reviews operative reports to determine if surgery services were appropriately billed.

• Reviews complex medical, legal and consult services.

• Contacts client or facility to obtain additional or missing information.

• Handles provider appeals as appropriate to fee schedule and contractual disputes.

• Identifies and effects reductions on selected medical bills that are determined to include inappropriate, unrelated or undocumented charges within state specific workers' compensation laws rules and regulations.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

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

• Travel as required.

Education & Licensing

Bachelor's degree from an accredited college or university preferred. RN license required.

Experience

Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years workers' compensation/bill review experience in multi-state jurisdiction; prior experience in PPO provider appeals, re-pricing, surgery review, by report and RNE review; two (2) years of experience with complex medical, legal and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review.

Skills & Knowledge

• Extensive knowledge of re-pricing rules and guidelines

• Knowledge of medical terminology, anatomy and surgical terminology

• Knowledge of CPT/ICD9

• PC literate, including Microsoft Office products

• High level of accuracy and attention to detail

• Ability to multi task and function in high volume area

• Problem solving skills and ability to handle deadlines

• 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.

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 $70,000-$72.000 . 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.

Always accepting applications.

#RN #billreview

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Return-to-Work Specialist

PRIMARY PURPOSE : To negotiate, facilitate and monitor successful return to work of claimants within appropriate disability duration guidelines; to determine specific physical tolerances and vocational skills required for specific employment positions as requested by referral sources or employers; to assist case management staff with client competence decisions for individual positions; to contact employers to gather specific job site/employment information and prepare related reports documenting results; to assist with job site modification and/or obtaining adaptive equipment necessary; and to ensure medical, legal and accreditation standards are maintained.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Determines objective, quantifiable, medically supported work restrictions for assigned claims.

• Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and claimant; completes all vocational/RTW related jurisdictional or client directed documentation, notification or reporting; documents client contact in claim notes as per Sedgwick CMS standards; and assists case management staff in making decisions regarding client's competence for specific position.

• Adheres to medical and legal regulations and accreditation standards in written communication.

• Develops contacts with company managers to introduce program; represents client.

• Contacts employers to determine specific information regarding employment area (i.e. training/education needed, physical demands, wages and benefits, availability, etc); ascertains the specific physical tolerances and vocational skills needed for specific employment positions as requested by referral sources or employers; assists in modifying job sites or obtaining necessary adaptive equipment as needed; and communicates with co-workers regarding specific employment areas to apprise them of labor trends.

• Maintains regular contact with clients following placement, as per program guidelines; contacts involved individuals regarding progress on each case and makes suggestions as needed for changing rehabilitation plans.

• Works closely with team members to ensure smooth transition from medical case management into job placement.

• Prepares reports to document research results.

• Performs other tasks related to vocational evaluation and work adjustment training as needed.

• Performs other duties as assigned.

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

• Good working knowledge of return-to work or job accommodation procedures

• Good technical knowledge of claims management procedures

• Excellent oral and written communications, including presentation skills

• PC literate, including Microsoft Office products

• 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 talkingThe 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.

• QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university. Certified Rehabilitation Counselor (CRC), Certified Disability Management Specialist (CDMS), or Certified Case Manager (CCM) designation preferred. Experience Four (4) years of related experience or equivalent combination of education and experience required, including one (1) year of return-to-work or job accommodation experience OR four (4) years of claims management experience.

• #CRC #CDMS #CCM

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 $60,000-$65,000. 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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Return-to-Work Specialist

PRIMARY PURPOSE : To negotiate, facilitate and monitor successful return to work of claimants within appropriate disability duration guidelines; to determine specific physical tolerances and vocational skills required for specific employment positions as requested by referral sources or employers; to assist case management staff with client competence decisions for individual positions; to contact employers to gather specific job site/employment information and prepare related reports documenting results; to assist with job site modification and/or obtaining adaptive equipment necessary; and to ensure medical, legal and accreditation standards are maintained.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Determines objective, quantifiable, medically supported work restrictions for assigned claims.

• Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and claimant; completes all vocational/RTW related jurisdictional or client directed documentation, notification or reporting; documents client contact in claim notes as per Sedgwick CMS standards; and assists case management staff in making decisions regarding client's competence for specific position.

• Adheres to medical and legal regulations and accreditation standards in written communication.

• Develops contacts with company managers to introduce program; represents client.

• Contacts employers to determine specific information regarding employment area (i.e. training/education needed, physical demands, wages and benefits, availability, etc); ascertains the specific physical tolerances and vocational skills needed for specific employment positions as requested by referral sources or employers; assists in modifying job sites or obtaining necessary adaptive equipment as needed; and communicates with co-workers regarding specific employment areas to apprise them of labor trends.

• Maintains regular contact with clients following placement, as per program guidelines; contacts involved individuals regarding progress on each case and makes suggestions as needed for changing rehabilitation plans.

• Works closely with team members to ensure smooth transition from medical case management into job placement.

• Prepares reports to document research results.

• Performs other tasks related to vocational evaluation and work adjustment training as needed.

• Performs other duties as assigned.

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

• Good working knowledge of return-to work or job accommodation procedures

• Good technical knowledge of claims management procedures

• Excellent oral and written communications, including presentation skills

• PC literate, including Microsoft Office products

• 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 talkingThe 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.

• QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university. Certified Rehabilitation Counselor (CRC), Certified Disability Management Specialist (CDMS), or Certified Case Manager (CCM) designation preferred. Experience Four (4) years of related experience or equivalent combination of education and experience required, including one (1) year of return-to-work or job accommodation experience OR four (4) years of claims management experience.

• #CRC #CDMS #CCM

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 $60,000-$65,000. 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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

RN Bill Review

PRIMARY PURPOSE : To review hospital and professional medical bills from providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Applies clinical editing.

• Reviews operative reports to determine if surgery services were appropriately billed.

• Reviews complex medical, legal and consult services.

• Contacts client or facility to obtain additional or missing information.

• Handles provider appeals as appropriate to fee schedule and contractual disputes.

• Identifies and effects reductions on selected medical bills that are determined to include inappropriate, unrelated or undocumented charges within state specific workers' compensation laws rules and regulations.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

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

• Travel as required.

Education & Licensing

Bachelor's degree from an accredited college or university preferred. RN license required.

Experience

Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years workers' compensation/bill review experience in multi-state jurisdiction; prior experience in PPO provider appeals, re-pricing, surgery review, by report and RNE review; two (2) years of experience with complex medical, legal and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review.

Skills & Knowledge

• Extensive knowledge of re-pricing rules and guidelines

• Knowledge of medical terminology, anatomy and surgical terminology

• Knowledge of CPT/ICD9

• PC literate, including Microsoft Office products

• High level of accuracy and attention to detail

• Ability to multi task and function in high volume area

• Problem solving skills and ability to handle deadlines

• 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.

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 $70,000-$72.000 . 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.

Always accepting applications.

#RN #billreview

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Return-to-Work Specialist

PRIMARY PURPOSE : To negotiate, facilitate and monitor successful return to work of claimants within appropriate disability duration guidelines; to determine specific physical tolerances and vocational skills required for specific employment positions as requested by referral sources or employers; to assist case management staff with client competence decisions for individual positions; to contact employers to gather specific job site/employment information and prepare related reports documenting results; to assist with job site modification and/or obtaining adaptive equipment necessary; and to ensure medical, legal and accreditation standards are maintained.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Determines objective, quantifiable, medically supported work restrictions for assigned claims.

• Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and claimant; completes all vocational/RTW related jurisdictional or client directed documentation, notification or reporting; documents client contact in claim notes as per Sedgwick CMS standards; and assists case management staff in making decisions regarding client's competence for specific position.

• Adheres to medical and legal regulations and accreditation standards in written communication.

• Develops contacts with company managers to introduce program; represents client.

• Contacts employers to determine specific information regarding employment area (i.e. training/education needed, physical demands, wages and benefits, availability, etc); ascertains the specific physical tolerances and vocational skills needed for specific employment positions as requested by referral sources or employers; assists in modifying job sites or obtaining necessary adaptive equipment as needed; and communicates with co-workers regarding specific employment areas to apprise them of labor trends.

• Maintains regular contact with clients following placement, as per program guidelines; contacts involved individuals regarding progress on each case and makes suggestions as needed for changing rehabilitation plans.

• Works closely with team members to ensure smooth transition from medical case management into job placement.

• Prepares reports to document research results.

• Performs other tasks related to vocational evaluation and work adjustment training as needed.

• Performs other duties as assigned.

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

• Good working knowledge of return-to work or job accommodation procedures

• Good technical knowledge of claims management procedures

• Excellent oral and written communications, including presentation skills

• PC literate, including Microsoft Office products

• 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 talkingThe 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.

• QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university. Certified Rehabilitation Counselor (CRC), Certified Disability Management Specialist (CDMS), or Certified Case Manager (CCM) designation preferred. Experience Four (4) years of related experience or equivalent combination of education and experience required, including one (1) year of return-to-work or job accommodation experience OR four (4) years of claims management experience.

• #CRC #CDMS #CCM

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 $60,000-$65,000. 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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

RN Bill Review

PRIMARY PURPOSE : To review hospital and professional medical bills from providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Applies clinical editing.

• Reviews operative reports to determine if surgery services were appropriately billed.

• Reviews complex medical, legal and consult services.

• Contacts client or facility to obtain additional or missing information.

• Handles provider appeals as appropriate to fee schedule and contractual disputes.

• Identifies and effects reductions on selected medical bills that are determined to include inappropriate, unrelated or undocumented charges within state specific workers' compensation laws rules and regulations.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

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

• Travel as required.

Education & Licensing

Bachelor's degree from an accredited college or university preferred. RN license required.

Experience

Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years workers' compensation/bill review experience in multi-state jurisdiction; prior experience in PPO provider appeals, re-pricing, surgery review, by report and RNE review; two (2) years of experience with complex medical, legal and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review.

Skills & Knowledge

• Extensive knowledge of re-pricing rules and guidelines

• Knowledge of medical terminology, anatomy and surgical terminology

• Knowledge of CPT/ICD9

• PC literate, including Microsoft Office products

• High level of accuracy and attention to detail

• Ability to multi task and function in high volume area

• Problem solving skills and ability to handle deadlines

• 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.

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 $70,000-$72.000 . 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.

Always accepting applications.

#RN #billreview

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

RN Bill Review

PRIMARY PURPOSE : To review hospital and professional medical bills from providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Applies clinical editing.

• Reviews operative reports to determine if surgery services were appropriately billed.

• Reviews complex medical, legal and consult services.

• Contacts client or facility to obtain additional or missing information.

• Handles provider appeals as appropriate to fee schedule and contractual disputes.

• Identifies and effects reductions on selected medical bills that are determined to include inappropriate, unrelated or undocumented charges within state specific workers' compensation laws rules and regulations.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

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

• Travel as required.

Education & Licensing

Bachelor's degree from an accredited college or university preferred. RN license required.

Experience

Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years workers' compensation/bill review experience in multi-state jurisdiction; prior experience in PPO provider appeals, re-pricing, surgery review, by report and RNE review; two (2) years of experience with complex medical, legal and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review.

Skills & Knowledge

• Extensive knowledge of re-pricing rules and guidelines

• Knowledge of medical terminology, anatomy and surgical terminology

• Knowledge of CPT/ICD9

• PC literate, including Microsoft Office products

• High level of accuracy and attention to detail

• Ability to multi task and function in high volume area

• Problem solving skills and ability to handle deadlines

• 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.

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 $70,000-$72.000 . 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.

Always accepting applications.

#RN #billreview

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Return-to-Work Specialist

PRIMARY PURPOSE : To negotiate, facilitate and monitor successful return to work of claimants within appropriate disability duration guidelines; to determine specific physical tolerances and vocational skills required for specific employment positions as requested by referral sources or employers; to assist case management staff with client competence decisions for individual positions; to contact employers to gather specific job site/employment information and prepare related reports documenting results; to assist with job site modification and/or obtaining adaptive equipment necessary; and to ensure medical, legal and accreditation standards are maintained.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Determines objective, quantifiable, medically supported work restrictions for assigned claims.

• Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and claimant; completes all vocational/RTW related jurisdictional or client directed documentation, notification or reporting; documents client contact in claim notes as per Sedgwick CMS standards; and assists case management staff in making decisions regarding client's competence for specific position.

• Adheres to medical and legal regulations and accreditation standards in written communication.

• Develops contacts with company managers to introduce program; represents client.

• Contacts employers to determine specific information regarding employment area (i.e. training/education needed, physical demands, wages and benefits, availability, etc); ascertains the specific physical tolerances and vocational skills needed for specific employment positions as requested by referral sources or employers; assists in modifying job sites or obtaining necessary adaptive equipment as needed; and communicates with co-workers regarding specific employment areas to apprise them of labor trends.

• Maintains regular contact with clients following placement, as per program guidelines; contacts involved individuals regarding progress on each case and makes suggestions as needed for changing rehabilitation plans.

• Works closely with team members to ensure smooth transition from medical case management into job placement.

• Prepares reports to document research results.

• Performs other tasks related to vocational evaluation and work adjustment training as needed.

• Performs other duties as assigned.

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

• Good working knowledge of return-to work or job accommodation procedures

• Good technical knowledge of claims management procedures

• Excellent oral and written communications, including presentation skills

• PC literate, including Microsoft Office products

• 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 talkingThe 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.

• QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university. Certified Rehabilitation Counselor (CRC), Certified Disability Management Specialist (CDMS), or Certified Case Manager (CCM) designation preferred. Experience Four (4) years of related experience or equivalent combination of education and experience required, including one (1) year of return-to-work or job accommodation experience OR four (4) years of claims management experience.

• #CRC #CDMS #CCM

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 $60,000-$65,000. 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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Return-to-Work Specialist

PRIMARY PURPOSE : To negotiate, facilitate and monitor successful return to work of claimants within appropriate disability duration guidelines; to determine specific physical tolerances and vocational skills required for specific employment positions as requested by referral sources or employers; to assist case management staff with client competence decisions for individual positions; to contact employers to gather specific job site/employment information and prepare related reports documenting results; to assist with job site modification and/or obtaining adaptive equipment necessary; and to ensure medical, legal and accreditation standards are maintained.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Determines objective, quantifiable, medically supported work restrictions for assigned claims.

• Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and claimant; completes all vocational/RTW related jurisdictional or client directed documentation, notification or reporting; documents client contact in claim notes as per Sedgwick CMS standards; and assists case management staff in making decisions regarding client's competence for specific position.

• Adheres to medical and legal regulations and accreditation standards in written communication.

• Develops contacts with company managers to introduce program; represents client.

• Contacts employers to determine specific information regarding employment area (i.e. training/education needed, physical demands, wages and benefits, availability, etc); ascertains the specific physical tolerances and vocational skills needed for specific employment positions as requested by referral sources or employers; assists in modifying job sites or obtaining necessary adaptive equipment as needed; and communicates with co-workers regarding specific employment areas to apprise them of labor trends.

• Maintains regular contact with clients following placement, as per program guidelines; contacts involved individuals regarding progress on each case and makes suggestions as needed for changing rehabilitation plans.

• Works closely with team members to ensure smooth transition from medical case management into job placement.

• Prepares reports to document research results.

• Performs other tasks related to vocational evaluation and work adjustment training as needed.

• Performs other duties as assigned.

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

• Good working knowledge of return-to work or job accommodation procedures

• Good technical knowledge of claims management procedures

• Excellent oral and written communications, including presentation skills

• PC literate, including Microsoft Office products

• 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 talkingThe 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.

• QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university. Certified Rehabilitation Counselor (CRC), Certified Disability Management Specialist (CDMS), or Certified Case Manager (CCM) designation preferred. Experience Four (4) years of related experience or equivalent combination of education and experience required, including one (1) year of return-to-work or job accommodation experience OR four (4) years of claims management experience.

• #CRC #CDMS #CCM

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 $60,000-$65,000. 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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

RN Bill Review

PRIMARY PURPOSE : To review hospital and professional medical bills from providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Applies clinical editing.

• Reviews operative reports to determine if surgery services were appropriately billed.

• Reviews complex medical, legal and consult services.

• Contacts client or facility to obtain additional or missing information.

• Handles provider appeals as appropriate to fee schedule and contractual disputes.

• Identifies and effects reductions on selected medical bills that are determined to include inappropriate, unrelated or undocumented charges within state specific workers' compensation laws rules and regulations.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

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

• Travel as required.

Education & Licensing

Bachelor's degree from an accredited college or university preferred. RN license required.

Experience

Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years workers' compensation/bill review experience in multi-state jurisdiction; prior experience in PPO provider appeals, re-pricing, surgery review, by report and RNE review; two (2) years of experience with complex medical, legal and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review.

Skills & Knowledge

• Extensive knowledge of re-pricing rules and guidelines

• Knowledge of medical terminology, anatomy and surgical terminology

• Knowledge of CPT/ICD9

• PC literate, including Microsoft Office products

• High level of accuracy and attention to detail

• Ability to multi task and function in high volume area

• Problem solving skills and ability to handle deadlines

• 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.

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 $70,000-$72.000 . 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.

Always accepting applications.

#RN #billreview

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Return-to-Work Specialist

PRIMARY PURPOSE : To negotiate, facilitate and monitor successful return to work of claimants within appropriate disability duration guidelines; to determine specific physical tolerances and vocational skills required for specific employment positions as requested by referral sources or employers; to assist case management staff with client competence decisions for individual positions; to contact employers to gather specific job site/employment information and prepare related reports documenting results; to assist with job site modification and/or obtaining adaptive equipment necessary; and to ensure medical, legal and accreditation standards are maintained.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Determines objective, quantifiable, medically supported work restrictions for assigned claims.

• Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and claimant; completes all vocational/RTW related jurisdictional or client directed documentation, notification or reporting; documents client contact in claim notes as per Sedgwick CMS standards; and assists case management staff in making decisions regarding client's competence for specific position.

• Adheres to medical and legal regulations and accreditation standards in written communication.

• Develops contacts with company managers to introduce program; represents client.

• Contacts employers to determine specific information regarding employment area (i.e. training/education needed, physical demands, wages and benefits, availability, etc); ascertains the specific physical tolerances and vocational skills needed for specific employment positions as requested by referral sources or employers; assists in modifying job sites or obtaining necessary adaptive equipment as needed; and communicates with co-workers regarding specific employment areas to apprise them of labor trends.

• Maintains regular contact with clients following placement, as per program guidelines; contacts involved individuals regarding progress on each case and makes suggestions as needed for changing rehabilitation plans.

• Works closely with team members to ensure smooth transition from medical case management into job placement.

• Prepares reports to document research results.

• Performs other tasks related to vocational evaluation and work adjustment training as needed.

• Performs other duties as assigned.

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

• Good working knowledge of return-to work or job accommodation procedures

• Good technical knowledge of claims management procedures

• Excellent oral and written communications, including presentation skills

• PC literate, including Microsoft Office products

• 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 talkingThe 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.

• QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university. Certified Rehabilitation Counselor (CRC), Certified Disability Management Specialist (CDMS), or Certified Case Manager (CCM) designation preferred. Experience Four (4) years of related experience or equivalent combination of education and experience required, including one (1) year of return-to-work or job accommodation experience OR four (4) years of claims management experience.

• #CRC #CDMS #CCM

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 $60,000-$65,000. 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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

RN Bill Review

PRIMARY PURPOSE : To review hospital and professional medical bills from providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Applies clinical editing.

• Reviews operative reports to determine if surgery services were appropriately billed.

• Reviews complex medical, legal and consult services.

• Contacts client or facility to obtain additional or missing information.

• Handles provider appeals as appropriate to fee schedule and contractual disputes.

• Identifies and effects reductions on selected medical bills that are determined to include inappropriate, unrelated or undocumented charges within state specific workers' compensation laws rules and regulations.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

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

• Travel as required.

Education & Licensing

Bachelor's degree from an accredited college or university preferred. RN license required.

Experience

Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years workers' compensation/bill review experience in multi-state jurisdiction; prior experience in PPO provider appeals, re-pricing, surgery review, by report and RNE review; two (2) years of experience with complex medical, legal and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review.

Skills & Knowledge

• Extensive knowledge of re-pricing rules and guidelines

• Knowledge of medical terminology, anatomy and surgical terminology

• Knowledge of CPT/ICD9

• PC literate, including Microsoft Office products

• High level of accuracy and attention to detail

• Ability to multi task and function in high volume area

• Problem solving skills and ability to handle deadlines

• 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.

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 $70,000-$72.000 . 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.

Always accepting applications.

#RN #billreview

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Return-to-Work Specialist

PRIMARY PURPOSE : To negotiate, facilitate and monitor successful return to work of claimants within appropriate disability duration guidelines; to determine specific physical tolerances and vocational skills required for specific employment positions as requested by referral sources or employers; to assist case management staff with client competence decisions for individual positions; to contact employers to gather specific job site/employment information and prepare related reports documenting results; to assist with job site modification and/or obtaining adaptive equipment necessary; and to ensure medical, legal and accreditation standards are maintained.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Determines objective, quantifiable, medically supported work restrictions for assigned claims.

• Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and claimant; completes all vocational/RTW related jurisdictional or client directed documentation, notification or reporting; documents client contact in claim notes as per Sedgwick CMS standards; and assists case management staff in making decisions regarding client's competence for specific position.

• Adheres to medical and legal regulations and accreditation standards in written communication.

• Develops contacts with company managers to introduce program; represents client.

• Contacts employers to determine specific information regarding employment area (i.e. training/education needed, physical demands, wages and benefits, availability, etc); ascertains the specific physical tolerances and vocational skills needed for specific employment positions as requested by referral sources or employers; assists in modifying job sites or obtaining necessary adaptive equipment as needed; and communicates with co-workers regarding specific employment areas to apprise them of labor trends.

• Maintains regular contact with clients following placement, as per program guidelines; contacts involved individuals regarding progress on each case and makes suggestions as needed for changing rehabilitation plans.

• Works closely with team members to ensure smooth transition from medical case management into job placement.

• Prepares reports to document research results.

• Performs other tasks related to vocational evaluation and work adjustment training as needed.

• Performs other duties as assigned.

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

• Good working knowledge of return-to work or job accommodation procedures

• Good technical knowledge of claims management procedures

• Excellent oral and written communications, including presentation skills

• PC literate, including Microsoft Office products

• 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 talkingThe 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.

• QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university. Certified Rehabilitation Counselor (CRC), Certified Disability Management Specialist (CDMS), or Certified Case Manager (CCM) designation preferred. Experience Four (4) years of related experience or equivalent combination of education and experience required, including one (1) year of return-to-work or job accommodation experience OR four (4) years of claims management experience.

• #CRC #CDMS #CCM

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 $60,000-$65,000. 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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

RN Bill Review

PRIMARY PURPOSE : To review hospital and professional medical bills from providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Applies clinical editing.

• Reviews operative reports to determine if surgery services were appropriately billed.

• Reviews complex medical, legal and consult services.

• Contacts client or facility to obtain additional or missing information.

• Handles provider appeals as appropriate to fee schedule and contractual disputes.

• Identifies and effects reductions on selected medical bills that are determined to include inappropriate, unrelated or undocumented charges within state specific workers' compensation laws rules and regulations.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

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

• Travel as required.

Education & Licensing

Bachelor's degree from an accredited college or university preferred. RN license required.

Experience

Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years workers' compensation/bill review experience in multi-state jurisdiction; prior experience in PPO provider appeals, re-pricing, surgery review, by report and RNE review; two (2) years of experience with complex medical, legal and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review.

Skills & Knowledge

• Extensive knowledge of re-pricing rules and guidelines

• Knowledge of medical terminology, anatomy and surgical terminology

• Knowledge of CPT/ICD9

• PC literate, including Microsoft Office products

• High level of accuracy and attention to detail

• Ability to multi task and function in high volume area

• Problem solving skills and ability to handle deadlines

• 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.

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 $70,000-$72.000 . 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.

Always accepting applications.

#RN #billreview

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Return-to-Work Specialist

PRIMARY PURPOSE : To negotiate, facilitate and monitor successful return to work of claimants within appropriate disability duration guidelines; to determine specific physical tolerances and vocational skills required for specific employment positions as requested by referral sources or employers; to assist case management staff with client competence decisions for individual positions; to contact employers to gather specific job site/employment information and prepare related reports documenting results; to assist with job site modification and/or obtaining adaptive equipment necessary; and to ensure medical, legal and accreditation standards are maintained.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Determines objective, quantifiable, medically supported work restrictions for assigned claims.

• Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and claimant; completes all vocational/RTW related jurisdictional or client directed documentation, notification or reporting; documents client contact in claim notes as per Sedgwick CMS standards; and assists case management staff in making decisions regarding client's competence for specific position.

• Adheres to medical and legal regulations and accreditation standards in written communication.

• Develops contacts with company managers to introduce program; represents client.

• Contacts employers to determine specific information regarding employment area (i.e. training/education needed, physical demands, wages and benefits, availability, etc); ascertains the specific physical tolerances and vocational skills needed for specific employment positions as requested by referral sources or employers; assists in modifying job sites or obtaining necessary adaptive equipment as needed; and communicates with co-workers regarding specific employment areas to apprise them of labor trends.

• Maintains regular contact with clients following placement, as per program guidelines; contacts involved individuals regarding progress on each case and makes suggestions as needed for changing rehabilitation plans.

• Works closely with team members to ensure smooth transition from medical case management into job placement.

• Prepares reports to document research results.

• Performs other tasks related to vocational evaluation and work adjustment training as needed.

• Performs other duties as assigned.

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

• Good working knowledge of return-to work or job accommodation procedures

• Good technical knowledge of claims management procedures

• Excellent oral and written communications, including presentation skills

• PC literate, including Microsoft Office products

• 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 talkingThe 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.

• QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university. Certified Rehabilitation Counselor (CRC), Certified Disability Management Specialist (CDMS), or Certified Case Manager (CCM) designation preferred. Experience Four (4) years of related experience or equivalent combination of education and experience required, including one (1) year of return-to-work or job accommodation experience OR four (4) years of claims management experience.

• #CRC #CDMS #CCM

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 $60,000-$65,000. 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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

RN Bill Review

PRIMARY PURPOSE : To review hospital and professional medical bills from providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Applies clinical editing.

• Reviews operative reports to determine if surgery services were appropriately billed.

• Reviews complex medical, legal and consult services.

• Contacts client or facility to obtain additional or missing information.

• Handles provider appeals as appropriate to fee schedule and contractual disputes.

• Identifies and effects reductions on selected medical bills that are determined to include inappropriate, unrelated or undocumented charges within state specific workers' compensation laws rules and regulations.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

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

• Travel as required.

Education & Licensing

Bachelor's degree from an accredited college or university preferred. RN license required.

Experience

Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years workers' compensation/bill review experience in multi-state jurisdiction; prior experience in PPO provider appeals, re-pricing, surgery review, by report and RNE review; two (2) years of experience with complex medical, legal and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review.

Skills & Knowledge

• Extensive knowledge of re-pricing rules and guidelines

• Knowledge of medical terminology, anatomy and surgical terminology

• Knowledge of CPT/ICD9

• PC literate, including Microsoft Office products

• High level of accuracy and attention to detail

• Ability to multi task and function in high volume area

• Problem solving skills and ability to handle deadlines

• 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.

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 $70,000-$72.000 . 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.

Always accepting applications.

#RN #billreview

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Return-to-Work Specialist

PRIMARY PURPOSE : To negotiate, facilitate and monitor successful return to work of claimants within appropriate disability duration guidelines; to determine specific physical tolerances and vocational skills required for specific employment positions as requested by referral sources or employers; to assist case management staff with client competence decisions for individual positions; to contact employers to gather specific job site/employment information and prepare related reports documenting results; to assist with job site modification and/or obtaining adaptive equipment necessary; and to ensure medical, legal and accreditation standards are maintained.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Determines objective, quantifiable, medically supported work restrictions for assigned claims.

• Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and claimant; completes all vocational/RTW related jurisdictional or client directed documentation, notification or reporting; documents client contact in claim notes as per Sedgwick CMS standards; and assists case management staff in making decisions regarding client's competence for specific position.

• Adheres to medical and legal regulations and accreditation standards in written communication.

• Develops contacts with company managers to introduce program; represents client.

• Contacts employers to determine specific information regarding employment area (i.e. training/education needed, physical demands, wages and benefits, availability, etc); ascertains the specific physical tolerances and vocational skills needed for specific employment positions as requested by referral sources or employers; assists in modifying job sites or obtaining necessary adaptive equipment as needed; and communicates with co-workers regarding specific employment areas to apprise them of labor trends.

• Maintains regular contact with clients following placement, as per program guidelines; contacts involved individuals regarding progress on each case and makes suggestions as needed for changing rehabilitation plans.

• Works closely with team members to ensure smooth transition from medical case management into job placement.

• Prepares reports to document research results.

• Performs other tasks related to vocational evaluation and work adjustment training as needed.

• Performs other duties as assigned.

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

• Good working knowledge of return-to work or job accommodation procedures

• Good technical knowledge of claims management procedures

• Excellent oral and written communications, including presentation skills

• PC literate, including Microsoft Office products

• 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 talkingThe 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.

• QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university. Certified Rehabilitation Counselor (CRC), Certified Disability Management Specialist (CDMS), or Certified Case Manager (CCM) designation preferred. Experience Four (4) years of related experience or equivalent combination of education and experience required, including one (1) year of return-to-work or job accommodation experience OR four (4) years of claims management experience.

• #CRC #CDMS #CCM

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 $60,000-$65,000. 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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

RN Bill Review

PRIMARY PURPOSE : To review hospital and professional medical bills from providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Applies clinical editing.

• Reviews operative reports to determine if surgery services were appropriately billed.

• Reviews complex medical, legal and consult services.

• Contacts client or facility to obtain additional or missing information.

• Handles provider appeals as appropriate to fee schedule and contractual disputes.

• Identifies and effects reductions on selected medical bills that are determined to include inappropriate, unrelated or undocumented charges within state specific workers' compensation laws rules and regulations.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

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

• Travel as required.

Education & Licensing

Bachelor's degree from an accredited college or university preferred. RN license required.

Experience

Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years workers' compensation/bill review experience in multi-state jurisdiction; prior experience in PPO provider appeals, re-pricing, surgery review, by report and RNE review; two (2) years of experience with complex medical, legal and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review.

Skills & Knowledge

• Extensive knowledge of re-pricing rules and guidelines

• Knowledge of medical terminology, anatomy and surgical terminology

• Knowledge of CPT/ICD9

• PC literate, including Microsoft Office products

• High level of accuracy and attention to detail

• Ability to multi task and function in high volume area

• Problem solving skills and ability to handle deadlines

• 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.

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 $70,000-$72.000 . 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.

Always accepting applications.

#RN #billreview

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Return-to-Work Specialist

PRIMARY PURPOSE : To negotiate, facilitate and monitor successful return to work of claimants within appropriate disability duration guidelines; to determine specific physical tolerances and vocational skills required for specific employment positions as requested by referral sources or employers; to assist case management staff with client competence decisions for individual positions; to contact employers to gather specific job site/employment information and prepare related reports documenting results; to assist with job site modification and/or obtaining adaptive equipment necessary; and to ensure medical, legal and accreditation standards are maintained.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Determines objective, quantifiable, medically supported work restrictions for assigned claims.

• Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and claimant; completes all vocational/RTW related jurisdictional or client directed documentation, notification or reporting; documents client contact in claim notes as per Sedgwick CMS standards; and assists case management staff in making decisions regarding client's competence for specific position.

• Adheres to medical and legal regulations and accreditation standards in written communication.

• Develops contacts with company managers to introduce program; represents client.

• Contacts employers to determine specific information regarding employment area (i.e. training/education needed, physical demands, wages and benefits, availability, etc); ascertains the specific physical tolerances and vocational skills needed for specific employment positions as requested by referral sources or employers; assists in modifying job sites or obtaining necessary adaptive equipment as needed; and communicates with co-workers regarding specific employment areas to apprise them of labor trends.

• Maintains regular contact with clients following placement, as per program guidelines; contacts involved individuals regarding progress on each case and makes suggestions as needed for changing rehabilitation plans.

• Works closely with team members to ensure smooth transition from medical case management into job placement.

• Prepares reports to document research results.

• Performs other tasks related to vocational evaluation and work adjustment training as needed.

• Performs other duties as assigned.

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

• Good working knowledge of return-to work or job accommodation procedures

• Good technical knowledge of claims management procedures

• Excellent oral and written communications, including presentation skills

• PC literate, including Microsoft Office products

• 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 talkingThe 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.

• QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university. Certified Rehabilitation Counselor (CRC), Certified Disability Management Specialist (CDMS), or Certified Case Manager (CCM) designation preferred. Experience Four (4) years of related experience or equivalent combination of education and experience required, including one (1) year of return-to-work or job accommodation experience OR four (4) years of claims management experience.

• #CRC #CDMS #CCM

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 $60,000-$65,000. 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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

RN Bill Review

PRIMARY PURPOSE : To review hospital and professional medical bills from providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Applies clinical editing.

• Reviews operative reports to determine if surgery services were appropriately billed.

• Reviews complex medical, legal and consult services.

• Contacts client or facility to obtain additional or missing information.

• Handles provider appeals as appropriate to fee schedule and contractual disputes.

• Identifies and effects reductions on selected medical bills that are determined to include inappropriate, unrelated or undocumented charges within state specific workers' compensation laws rules and regulations.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

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

• Travel as required.

Education & Licensing

Bachelor's degree from an accredited college or university preferred. RN license required.

Experience

Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years workers' compensation/bill review experience in multi-state jurisdiction; prior experience in PPO provider appeals, re-pricing, surgery review, by report and RNE review; two (2) years of experience with complex medical, legal and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review.

Skills & Knowledge

• Extensive knowledge of re-pricing rules and guidelines

• Knowledge of medical terminology, anatomy and surgical terminology

• Knowledge of CPT/ICD9

• PC literate, including Microsoft Office products

• High level of accuracy and attention to detail

• Ability to multi task and function in high volume area

• Problem solving skills and ability to handle deadlines

• 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.

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 $70,000-$72.000 . 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.

Always accepting applications.

#RN #billreview

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick

Job 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 WorkR

Most Loved WorkplaceR

Forbes Best-in-State Employer

Return-to-Work Specialist

PRIMARY PURPOSE : To negotiate, facilitate and monitor successful return to work of claimants within appropriate disability duration guidelines; to determine specific physical tolerances and vocational skills required for specific employment positions as requested by referral sources or employers; to assist case management staff with client competence decisions for individual positions; to contact employers to gather specific job site/employment information and prepare related reports documenting results; to assist with job site modification and/or obtaining adaptive equipment necessary; and to ensure medical, legal and accreditation standards are maintained.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Determines objective, quantifiable, medically supported work restrictions for assigned claims.

• Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and claimant; completes all vocational/RTW related jurisdictional or client directed documentation, notification or reporting; documents client contact in claim notes as per Sedgwick CMS standards; and assists case management staff in making decisions regarding client's competence for specific position.

• Adheres to medical and legal regulations and accreditation standards in written communication.

• Develops contacts with company managers to introduce program; represents client.

• Contacts employers to determine specific information regarding employment area (i.e. training/education needed, physical demands, wages and benefits, availability, etc); ascertains the specific physical tolerances and vocational skills needed for specific employment positions as requested by referral sources or employers; assists in modifying job sites or obtaining necessary adaptive equipment as needed; and communicates with co-workers regarding specific employment areas to apprise them of labor trends.

• Maintains regular contact with clients following placement, as per program guidelines; contacts involved individuals regarding progress on each case and makes suggestions as needed for changing rehabilitation plans.

• Works closely with team members to ensure smooth transition from medical case management into job placement.

• Prepares reports to document research results.

• Performs other tasks related to vocational evaluation and work adjustment training as needed.

• Performs other duties as assigned.

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

• Good working knowledge of return-to work or job accommodation procedures

• Good technical knowledge of claims management procedures

• Excellent oral and written communications, including presentation skills

• PC literate, including Microsoft Office products

• 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 talkingThe 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.

• QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university. Certified Rehabilitation Counselor (CRC), Certified Disability Management Specialist (CDMS), or Certified Case Manager (CCM) designation preferred. Experience Four (4) years of related experience or equivalent combination of education and experience required, including one (1) year of return-to-work or job accommodation experience OR four (4) years of claims management experience.

• #CRC #CDMS #CCM

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 $60,000-$65,000. 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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Detail

• Company:
  Sedgwick