Remote Disability Clinical Specialist

Sedgwick; Des Moines (IA); Remote; USD 66,000 - 90,000; Full time

Job summary

Sedgwick is seeking a Telecommuter Disability Clinical Specialist to perform medical reviews and provide case direction. The role requires clinical expertise and strong communication with employees and providers across multiple states.

Ideal candidates hold RN/LPN/LVN or related licenses with at least four years of medical/psychology experience and will support claims decisions while maintaining high quality audit performance.

Qualifications

• Bachelor's degree or equivalent preferred.
• RN, LVN, LPN, CRC, COHN CVE, LPC or LCSW licenses required.
• Four years of related experience in medical/psychological settings or equivalent.

Responsibilities

• Performs standard clinical reviews of referred medical claims based on client requirements to ensure accurate and sufficient information is received by employees and providers to support the claim request and documents decision rationale.
• Completes medical review of all claims by reviewing medical documentation and applying clinical knowledge to ensure information substantiates disability and job function impact.
• Communicates clearly with employees and providers to discuss clinical status, progress, and work status.
• Provides follow-up recommendations for ongoing medical management of claims and ensures appropriate guidance.
• Acts as clinical resource to claims examiners for medical management guidance.

Skills

Medical/Clinical knowledge

Communication

Microsoft Office

Analytical skills

Organizational skills

Team collaboration

Judgment & decision making

Education

Bachelor's degree or equivalent

RN

LVN

LPN

CRC

COHN CVE

LPC/LCSW

Job description

Sedgwick is seeking a Telecommuter Disability Clinical Specialist to perform medical reviews and provide case direction. The role requires clinical expertise and strong communication with employees and providers across multiple states.

Ideal candidates hold RN/LPN/LVN or related licenses with at least four years of medical/psychology experience and will support claims decisions while maintaining high quality audit performance.