Telephonic Case Manager

Sedgwick Claims Management Services Ltd; Kentucky; Hybrid; USD 70,000 - 72,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) with matching

Paid time off (PTO)

Job summary

Sedgwick is seeking a Telephonic Case Manager (RN) to collaborate with injured workers, employers, and medical providers. You will assess medical needs by phone, develop a return-to-work plan, and advocate for timely, appropriate care while maintaining privacy and quality standards.

The role offers remote work with flexible daily routines, ongoing professional development, and a supportive team culture. A BSN and active RN license in the U.S.

Qualifications

• RN license required in the United States.
• BSN from an accredited program preferred.
• Certification in case management or rehabilitation nursing is highly preferred.

Responsibilities

• Performs initial and ongoing clinical assessment via telephone to evaluate injury, treatment, and support needs.
• Communicates effectively with claims examiner, client, injured worker, attorney, and supervisor.
• Identifies barriers to recovery and return-to-work; applies creative problem solving.
• Negotiates treatment and disability duration with providers using guidelines and quality standards.
• Suggests alternative clinical resources to support claim resolution and cost containment.
• Maintains client privacy and confidentiality and adheres to regulatory standards.

Skills

RN license

Clinical assessment via telephone

Communication with stakeholders

Education

RN license in the United States

BSN

Case management certification (preferred)

Job description

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Telephonic Case Manager

PRIMARY PURPOSE OF THE ROLE:

While partnering with the injured worker, employer, and medical providers, create a case management strategy to facilitate medical recovery and a successful return to work through advocacy, communication and coordination of medical services.

ARE YOU AN IDEAL CANDIDATE?

We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work. Apply your medical/clinical or rehabilitation knowledge and experience to assist in the management of complex medical conditions, treatment planning and recovery from illness or injury. Work in the best of both worlds - a rewarding career making an impact on the health and lives of others, and a remote work environment. Enjoy flexibility and autonomy in your daily work, your location, and your career path while advocating for the most effective and efficient medical treatment for injured employees in a non-traditional setting. Enable our Caring counts® mission supporting injured employees from some of the world’s best brands and organizations. Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. Celebrate your career achievements and each other through professional development opportunities, continuing education credits, team building initiatives and more. Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE:

• Performs initial and ongoing clinical assessment via telephone calls to evaluate the injured worker's injury, medical treatment, psychosocial needs, cultural implications and support systems.
• Effectively communicates and builds relationships with the claims’ examiner, client, injured worker, attorney and supervisor.
• Identifies issues related to delayed recovery and/or return to work and problem solves with a creative thinking approach.
• Negotiates treatment and disability duration with providers through use of medical and disability duration guidelines, adhering to quality.
• Identifies opportunities to expedite care for cost containment and timely medical recovery.
• Provides recommendations for alternate clinical resources to support claim resolution.
• Maintains client's privacy and confidentiality, promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards.

EDUCATION AND LICENSING:

Current unrestricted RN license(s) in a state or territory of the United States required. Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred. Certification in case management, rehabilitation nursing or a related specialty is highly preferred.

TAKING CARE OF YOU BY:

• Offering flexibility and autonomy.
• Supporting meaningful work that promotes critical thinking and problem solving.
• Providing on-going learning and professional growth opportunities.
• Promoting a strong team environment and a culture of support.
• Recognizing your successes and celebrating your achievements.
• Thrives when everyone is working towards the same vision/goals.

WORK ENVIRONMENT REQUIREMENTS INCLUDE:

• 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
• Auditory/Visual: Hearing, vision and talking

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.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.

Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape.