Telephonic Case Manager

Sedgwick; San Juan (PR); Remote; USD 73,000 - 75,000; Full time

Benefits offered by this job

Medical, dental, vision plans

401K plan with company match

Paid time off (PTO)

Job summary

Sedgwick, a global leader in risk and claims administration, seeks a Telephonic Case Manager (RN) to work remotely in the United States. You will partner with injured workers, employers, and medical providers to coordinate care and support timely return to work through advocacy and coordination of services.

The role emphasizes communication, clinical assessment, and adherence to privacy and regulatory standards, with opportunities for professional growth in a flexible remote environment.

Qualifications

• Current unrestricted RN license in US required.
• BSN preferred or equivalent experience in clinical care.
• Certification in case management or rehabilitation nursing preferred.

Responsibilities

• Performs initial and ongoing clinical assessment via telephone to evaluate injury and needs.
• Communicates effectively with claims examiner, client, injured worker, attorney and supervisor.
• Identifies delays to recovery and uses creative problem solving to resolve issues.
• Negotiates treatment and disability duration with providers based on guidelines.
• Identifies opportunities to expedite care for cost containment and recovery.
• Maintains client privacy and adheres to regulatory standards.

Skills

RN license

Clinical knowledge

Communication

Problem solving

Advocacy

Education

BSN preferred

Case management certification preferred

Tools

EMR systems

Case management software

Job description

US Telecommuter

Full time

R74553

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.

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.

Auditory/Visual: Hearing, vision and talking

TAKING CARE OF YOU BY

• Offering a blended work environment.

• 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.

• We offer a diverse and comprehensive benefits package including:

• Three medical, and two dental & vision plans to choose from.

• Tuition reimbursement

• 401K plan that matches 50% on every $ you put in up to the first 6% you save.

• 4 weeks PTO your first full year.

NEXT STEPS

If your application is selected to advance to the next round, a recruiter will be in touch.

#nurse #telephoniccasemanager

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 $73,000 - $75,000. 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.

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.

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. For more, see sedgwick.com