Clinical Manager

PRIMARY PURPOSE: To ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients by managing and training either a dedicated unit or multiple units of colleagues located in claims offices and on site at client locations; to provide expertise in client specific case management and utilization review requirements; and to ensure customer satisfaction through the provision of these 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.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Manages overall clinical operations for less than three (3) assigned teams/offices or one (1) large dedicated unit; assists in developing and implementing clinical objectives and initiatives.
• Assists with implementation of new business plan with goals and objectives for assigned locations/offices; provides expert medical and product support to Sedgwick CMS claims and clinical staff.
• Promotes and adheres to all URAC standards and assures compliance to maintain successful URAC certification.
• Identifies challenges and creates solution for recruitment, hiring, staffing, process management and training needs; plans for staffing needs, including succession, bench-strength and new business; and supervises, coordinates and reviews the work of assigned staff.
• Assists in establishing policy and procedures to assure compliance to best practices, clinical management services standards, state regulations, and client service requirements.
• Monitors management reports relating to the area/office performance.
• Delivers corporate training for clinical staff in conjunction with Sedgwick University; provides direct oversight of clinical orientation program; and coordinates with Sedgwick University for certification of training materials.
• Provides assistance to the Director Clinical Operations in making budget recommendations; manages budget ensuring achievement of unit financial goals; ensures effective deployment of strategic project plans.
• Identifies potential new product opportunities, processes and protocols; participates in presentations to clients, prospects and colleagues.
• Supports and interfaces with account management; provides expertise in client specific case management and utilization review requirements; and develops and maintains positive, productive relationships.

SUPERVISORY RESPONSIBILITIES

• Administers company personnel policies in all areas and follows company staffing standards and training recommendations.
• Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions.
• Provides support, guidance, leadership and motivation to promote maximum performance.

Education & Licensing

Bachelor's degree in nursing (BSN) or master's degree in Vocational Rehabilitation from an accredited college or university or equivalent work Experience preferred. Certification in case management or certification in rehab counseling preferred. Valid driver's license required.

Experience

Eight (8) years of related experience or equivalent combination of education and experience required to include three (3) years of medical or vocational case management, three (3) years clinical or three (3) years of vocational, and two (2) years supervisory experience. Workers compensation or disability experience preferred.

Skills & Knowledge

• Knowledge of multiple business line medical and vocational case management environments
• Knowledge of resources available regarding the regulations and parameters of third party reimbursement, benefit determinations, and payments
• Knowledge of statutory requirements of state's jurisdiction as appropriate to job
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Leadership/management/motivational skills
• 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

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.

• We offer a diverse and comprehensive benefits including medical, dental vision, 401K, PTO and more beginning your first day.

NEXT STEPS

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

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 $100,000-$107,000. 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.