RN Medicare Compliance-Proactive Reduction Outreach

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive. 

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.

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PRIMARY PURPOSE:  To perform initial and ongoing clinical assessment through provider outreach, specialized document review, and analysis and interpretation of interventions for the preparation of Medicare Set-Aside allocations.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Contacts providers and attorneys to obtain clarification of documentation needed to support the preparation of Medicare Set-Aside allocations.
• Uses specialized knowledge to assess the needs of the individual case and creates customized correspondence for any applicable providers that will provide the clarity needed to proceed with the preparation of the Medicare Set-Aside.
• Proactively and strategically plans and executes outreach activities with providers for each case via telephone, email, and fax, adhering to best practice guidelines. 
• Reviews and analyzes completed documentation from providers to ensure accuracy, completeness, adherence to quality assurance standards.
• Measures interventions to determine the outcome of the clinical assessment involvement to include efficacy of response, financial, and client satisfaction; maintains accurate record of management including costs, savings.
• Articulates and effectively documents clear and concise information with handling planner, specialist, client, and supervisor while maintaining client's privacy and confidentiality; adheres to ethical, legal, accreditation and regulatory standards.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

QUALIFICATIONS

Education & Licensing
Bachelor's degree from an accredited college or university preferred.  Active unrestricted RN license issued in a state or territory of the United States required. 

Experience

Four (4) years of related experience or equivalent combination of education and experience required.

Skills & Knowledge

• Excellent oral and written communication skills, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Ability to create and complete comprehensive, accurate and constructive written reports
• 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 deadlines

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 $65,000-$68,000. 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.