Clinical Director

PRIMARY PURPOSE:: To ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients for multiple business lines by managing and training 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.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES
 

• Manages overall clinical operations for more than 3 assigned teams/offices; develops and implements 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 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; managing budget to ensure 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.

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
For Managed Care:
Current unrestricted RN license in a state or territory of the United States required. Certification in case management required. Bachelor's degree in nursing (BSN) from an accredited college or university or equivalent work Experience preferred.

For Disability:

Current unrestricted RN license in a state or territory of the United States required or Certified Rehabilitation Counselor (CRC) or Licensed Clinical Social Worker (LCSW) required in lieu of a Bachelor's degree in nursing (BSN) from an accredited college or university or equivalent work experience.

 
Experience

Ten (10) years of related experience or equivalent combination of education and experience required to include five (5) years medical case management, five (5) years clinical and two (2) years supervisory experience. Workers compensation or disability experience preferred.

Skills & Knowledge
 

• Knowledge of multiple business line medical case management environments
• Knowledge of resources available regarding the regulations and parameters of third party reimbursement
• 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

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
 

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 106,000-$115,000. 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.