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

Sr Clinical Team Lead

PRIMARY PURPOSE: To ensure efficient, cost effective, and high quality delivery of case management services to clients for multiple business lines by supervising and training multiple units of colleagues located on-site at client locations, overseeing the management of cases worked by field specialists, and providing expertise in client union involvement and client specific case management requirements; and to ensure customer satisfaction through the provision of these services and through dealing directly with multiple business line claims managers, supervisors and examiners utilizing the account management process.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Plans for staffing needs including succession, bench-strength, and new business.
• Establishes business plan with goals and objectives for the area and locations/offices.
• Establishes policy and procedures to assure compliance to best practices, claims management services standards, state regulations, and client service requirements.
• Supervises, coordinates, and reviews the work of assigned staff for a single business line while on-site at client locations.
• Makes budget recommendations; manages assigned budget to ensure achievement of unit financial goals.
• Acts as liaison between telephonic and onsite case management.
• Participates in account support and management.
• Provides expertise in client specific case management requirements and in client union involvement.
• Provides expert medical and product support to staff.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travels as required.

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.

QUALIFICATIONS

Education & Licensing
One of the following is required:

• Bachelor's degree or higher in a health-related field AND licensure as a health professional (where such licensure is available) or
• Certification as a case manager or
• Professional certification in a clinical specialty with three (3) years experience as case manager AND certification as case manager if directly supervising case management process experience
• Eight (8) years of related experience or equivalent combination of education and experience required to include three (3) years medical case management, two (2) years clinical and two (2) years supervisory experience.

Skills & Knowledge

• Solid knowledge of multiple business line medical 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/ERISA regulations
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Good leadership/management/motivational skills
• Strong 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 deadline

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 $85,000-$87.000. 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.