Utilization Review Assistant - Memphis TN

Sedgwick Claims Management Services, Inc. Memphis, TN
Utilization Review Assistant

Providing both satisfying and challenging work along with a highly professional and friendly work atmosphere, Sedgwick Claims Management Services, Inc. has a strong commitment to its colleagues and its clients. If you are seeking a place where you can do great things for those whose lives you touch while maximizing your own career possibilities, Sedgwick CMS is the place for you. As the largest and most innovative Third Party Administrator in the claims industry and the first and only TPA to receive both recognition as the Best TPA in America and the coveted Employer of Choice designation, we invite you to come be a part of our team and, "Claim Your Future."

PRIMARY PURPOSE: To assist in evaluating the medical necessity, appropriateness and efficiency of the health care services.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

* Assists in evaluating the medical necessity, appropriateness and efficiency of the use of health care services as assigned.

* Responds to requests for authorization for services utilizing appropriate guidelines.

* Verifies injury and/or occupational disease process that prevents full return-to-work (RTW) status.

* Reviews cases for remain-at-work and vocational rehabilitation services.

* Assists with utilization management quality assurance initiatives through participation in on-line log and/or case staffing with supervisor.

* Completes C-9s, vocational referrals and ER reviews within guidelines as assigned; documents all activities and communications in appropriate system(s).

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

* Performs other duties as assigned.

* Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing

High school diploma or GED required.

Experience

One (1) year of experience with workers compensation legal and regulatory requirements and quality/managed care concepts or equivalent combination of education and experience required.

Skills & Knowledge

* Knowledge of workers compensation claims procedures and state legal and regulatory requirements

* Good customer service skills

* Good oral and written communication skills

* PC literate, including Microsoft Office products

* Excellent interpersonal skills

* Good organizational and time management skills

* Good problem solving skills

* Good analytical skills

* Ability to manage multiple and changing priorities

* Ability to work in a team environment or independently with little supervision

* 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

Sedgwick CMS is an Equal Opportunity Employer

and a

Drug-Free Workplace

Similar jobs you might like