Clinical Behavioral Health Specialist - Sedgwick Claims Management Services, Inc.

PRIMARY PURPOSE: To identify and address psychosocial, medical, and employment issues within a claim and be actively engaged in resolution; to work in conjunction with and provide recommendations and education to the claims examiner, claimant, and clinical team; to work with the clinical team and claimant to overcome medical and return-to-work (RTW) barriers; to establish positive claimant relationships and aid in reducing litigation; and to serve as a resource to the claimant and other members of the clinical team

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Identifies claimant's psychosocial issues/needs, related barriers, and post traumatic injury/incident.
• Assesses claimant's situation for psychosocial needs, cultural implications, and support systems in place.
• Develops a plan to improve medical progression, return to work, and reduce litigation.
• Provides counseling, ongoing assessment and addresses personal and team goals to ensure appropriate resources are available to claimant.
• Promotes patient advocacy and interacts with the claimant in a positive manner.
• Communicates clearly with claimants, physicians, claim examiners, and other members of the clinical team and maintains professional client relationships.
• Performs clinical assessment of claimant, physician, employer and attorney if appropriate.
• Creates a case management plan based on the assessment with measurable goals and objectives utilizing evidence-based criteria.
• Monitors ongoing progress toward these goals and objectives; implements plan through case management interventions.
• Maintains case and unit goals to achieve optimal outcomes and customer service/satisfaction goals.
• Manages assigned cases timely and facilitates claim closure based on treatment goals and return-to-work issues.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.

• Supports the organization's quality program(s).
• Travels as required.

QUALIFICATIONS
 

Education & Licensing

Master's degree from an accredited college or university in social work, psychology, or counseling required.  Independent clinical license at the master’s level- Licensed Clinical Social Worker (LCSW), Licensed Independent Clinical Social Worker (LICSW), Licensed Master Social Worker (LMSW), Certified Independent Practice Social Worker (CIPSW), Independent Social Worker (ISW), Licensed Clinical Professional Counselor (LCPC), or Licensed Professional Clinical Counselor (LPCC), or equivalent in colleague state required. Spanish as a second language preferred.

Experience

Six (6) years of related experience or equivalent combination of education and experience required to include four (4) years of clinical experience. Experience conducting psychosocial assessments preferred.

Skills & Knowledge
Solid clinical knowledge of psychiatric disease processes including familiarity with DSM-5 guidelines

• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Leadership/management/motivational skills
• Strong organizational skills
• Excellent interpersonal 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

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 $75,000-$77,000. 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.

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