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 Telephonic Case Manager PRIMARY PURPOSE OF THE ROLE: While partnering with the injured worker, employer, and medical providers, create a case management strategy to facilitate medical recovery and a successful return to work through advocacy, communication and coordination of medical services. ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work. - Apply your medical/clinical or rehabilitation knowledge and experience to assist in the management of complex medical conditions, treatment planning and recovery from illness or injury. - Work in the best of both worlds - a rewarding career making an impact on the health and lives of others, and a remote work environment. - Enjoy flexibility and autonomy in your daily work, your location, and your career path while advocating for the most effective and efficient medical treatment for injured employees in a non-traditional setting. - Enable our Caring counts® mission supporting injured employees from some of the world’s best brands and organizations. - Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. - Celebrate your career achievements and each other through professional development opportunities, continuing education credits, team building initiatives and more. - Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. ESSENTIAL RESPONSIBLITIES MAY INCLUDE - Performs initial and ongoing clinical assessment via telephone calls to evaluate the injured worker's injury, medical treatment, psychosocial needs, cultural implications and support systems. - Effectively communicates and builds relationships with the claims’ examiner, client, injured worker, attorney and supervisor. - Identifies issues related to delayed recovery and/or return to work and problem solves with a creative thinking approach - Negotiates treatment and disability duration with providers through use of medical and disability duration guidelines, adhering to quality. - Identifies opportunities to expedite care for cost containment and timely medical recovery. - Provides recommendations for alternate clinical resources to support claim resolution. - Maintains client's privacy and confidentiality, promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards. EDUCATION AND LICENSING Current unrestricted RN license(s) in a state or territory of the United States required. Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred. Certification in case management, rehabilitation nursing or a related specialty is highly preferred. ​ TAKING CARE OF YOU BY - Offering a blended work environment. - Supporting meaningful work that promotes critical thinking and problem solving. - Providing on-going learning and professional growth opportunities. - Promoting a strong team environment and a culture of support. - Recognizing your successes and celebrating your achievements. - Thrives when everyone is working towards the same vision/goals. - We offer a diverse and comprehensive benefits package including: - Three Medical, and two dental plans to choose from. - Tuition reimbursement eligible. - 401K plan that matches 50% on every $ you put in up to the first 6% you save. - 4 weeks PTO your first full year. NEXT STEPS If your application is selected to advance to the next round, a recruiter will be in touch. #nurse #telephoniccasemanager 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 $73,000 - $75,000. 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. Always accepting applications. 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.

A Brief Overview Applies clinical expertise and knowledge of health care workflows in order to educate and train CDI Specialists in the essential duties of their role to improve the overall accuracy and comprehensiveness of medical record documentation, with focus on ensuring accurate reporting of quality outcomes Educates CDI Specialists on the rules/regulations associated with coding and clinical documentation integrity. Trains newly hired CDI Specialists and provides ongoing coaching and education specific to daily CDI Specialist job functions. Ensures the work output of the Clinical Documentation Integrity staff is accurate and compliant. Collaborates with CDI leadership and Coding team to identify training opportunities and assist with education of CDI and Coding staff with regard to clinical documentation integrity and/or clinical and coding scenarios as needed. What You Will Do - Performs post-discharge, final coded, pre-bill reviews of targeted records identified for second-level review for opportunity to accurately capture patient acuity, severity of illness, risk of mortality, and DRG assignment in compliance with industry rules and regulations • Documents SLR findings within CDI application. ◦ If a documentation opportunity is identified, place physician query and follow up for response to ensure completeness and accuracy of the medical record. ◦ If coding opportunity is identified, coordinate with coder and/or Coding Leadership to review and address opportunity as applicable - Serves as a role model and resource for CDI team members • Subject matter expert that exhibits excellent skills in essential components of the CDI Specialist role • Responds to CDS requests for concurrent chart reviews on challenging cases with recommendations and supporting rationale ◦ Performs concurrent second level reviews based on defined criteria and shares feedback with CDI Specialist assigned to the encounter for action on opportunities identified. - Maintains a summary of opportunities identified through second level review for feedback and education with the CDI team • Coordinates with other Second Level Reviewers, CDI Leads, and CDI Educator to compile trends and areas of opportunity and conduct education both 1:1 and group education with the CDI team based on the findings - Periodically review the criteria established for cases triggering a second level review and recommend updates or modifications to the criteria to assist in identifying areas of opportunity - Is actively engaged in quality and process improvement efforts • Performs targeted audits as assigned in support of department initiatives • Participates in quality initiatives such as HAC/PSI and US News/Mortality • Collaborates with CDI Leadership, Leads and Educators to optimize query templates • Identifies and shares feedback regarding workflow improvement opportunities identified when completing the SLR process • Facilitates change and supports the CDI team through change management processes • Actively engages in advancing the CDI practice throughout the UH enterprise • Actively engages in department and/or enterprise-wide committee Additional Responsibilities - Performs other duties as assigned. - Complies with all policies and standards. - For specific duties and responsibilities, refer to documentation provided by the department during orientation. - Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace. Education - Other Accredited Program: Diploma in Nursing or in Health Information Management (Required) or - Associate's Degree preferably in Health Information Management or Nursing (Required) or - Bachelor's Degree preferably in Health Information Management or Nursing (Required) or - Doctorate Degree in Medicine (Required) Work Experience - 3+ years CDI experience as a concurrent reviewer (Required) Knowledge, Skills, & Abilities - Extensive clinical knowledge and understanding of pathology/physiology; best demonstrated by clinical experience in hospital setting (Required proficiency) - Strong critical thinking skills and the ability to review the medical record to identify information not yet documented but supported by clinical indicators or clinical clues (Required proficiency) - Demonstrates comprehension of Case Mix Index (CMI) and can interpret, analyze, evaluate data, provide rationale for trends/impacting factors and develop strategy for correcting/optimizing CMI (Required proficiency) - Knowledge of age-specific patient needs and the elements of disease processes and related procedures (Required proficiency) - Excellent written and verbal communication skills; ability to write concisely and effectively when communicating with providers (Required proficiency) - Assertive personality traits to facilitate ongoing physician communication (Required proficiency) - Working knowledge of inpatient admission criteria. (Required proficiency) - Ability to work independently in a time-oriented environment as well as working as part of a team, primarily in a virtual setting. (Required proficiency) - Applies knowledge and expertise to daily job responsibilities. Maintains professional knowledge by reading and/or attending webinars that pertain to Clinical Documentation Improvement. (Required proficiency) - Earns and maintains Certification for Clinical Documentation Improvement. (Required proficiency) - Incorporates current literature, research and best practice ( ACDIS and AHIMA ) into daily practice. (Required proficiency) - Up to-date clinical and coding experience, and current working knowledge of pathology, pharmacology, surgical procedures, etc. (Required proficiency) - Detail-oriented and organized, have excellent time-management skills, and have good analytical and problem-solving ability. (Required proficiency) - Notable client service, communication, presentation and relationship building skills. (Required proficiency) Licenses and Certifications - Registered Nurse (RN), Ohio and/or Multi State Compact License (Required Upon Hire) or - Registered Health Information Administration (RHIA) (Required Upon Hire) or - Registered Health Information Technologist (RHIT) (Required Upon Hire) and - Certified Clinical Documentation Specialist (CCDS) (Required Upon Hire) or - Clinical Documentation Improvement Practitioner (CDIP) (Required Upon Hire) - International medical doctor education and experience can meet qualifications in lieu of RN, RHIA or RHIT Physical Demands - Standing Occasionally - Walking Occasionally - Sitting Constantly - Lifting Rarely up to 20 lbs - Carrying Rarely up to 20 lbs - Pushing Rarely up to 20 lbs - Pulling Rarely up to 20 lbs - Climbing Rarely up to 20 lbs - Balancing Rarely - Stooping Rarely - Kneeling Rarely - Crouching Rarely - Crawling Rarely - Reaching Rarely - Handling Occasionally - Grasping Occasionally - Feeling Rarely - Talking Constantly - Hearing Constantly - Repetitive Motions Frequently - Eye/Hand/Foot Coordination Frequently Travel Requirements - 10%25

Qualified candidates must hold a current, unrestricted license in the state of New York. Who We Are At Lucet, we’re transforming whole-person care. We deliver integrated behavioral and physical health solutions that connect individuals to the right care at the right time—improving outcomes and overall well-being. Serving over 15 million lives across the U.S. and Puerto Rico, our model combines clinical expertise, compassionate care, and innovative technology to support healthier, more fulfilling lives. As part of the Lucet team, employees join a mission-driven organization committed to making a lasting impact. Whether through behavioral health navigation, in-home medical care, or 24/7 crisis support, our work is rooted in empathy, collaboration, and a shared passion for helping people thrive. Why join our team at Lucet? At Lucet, we’re committed to creating a workplace where top talent thrives both personally and professionally. We offer a dynamic, mission-driven environment where your work has real impact, your unique background and experience are valued, and no two days are alike. If you’re passionate about meaningful work and delivering impactful results, we encourage you to apply! - Compensation: The collaborating physician will receive a set monthly stipend between $1,000 and $1,500, determined by the agreed-upon scope and responsibilities At Lucet, your work will directly support our mission to improve behavioral, physical, and social health—one member at a time. What You Will Do - Essential Functions Collaborating Physicians provide clinical oversight for three different departments, In Home Assessments (IHA), CareSight (CS) and ISNP. IHAs are performed annually and require little to no medical intervention. APP’s complete a comprehensive history and physical and recommend services to close care gaps and identify needs of the patient. CS APP’s visit patients with chronic diseases monthly, quarterly and prn to decrease hospital admissions by managing chronic conditions and helping the health plan’s members live a healthier lifestyle. ISNP APP’s provide comprehensive care to the health plan members located in a nursing facility. CS requires communication with PCPs and more intervention and supervision by our Collaborative Physicians. - Provides oversight of Advance Practice Providers (APPs) who provide health care to patients located in their home or a nursing facility. - Available for consult with the APP via telephonic or electronic means. - Responsible for chart reviews for APPs as required by the state. - Sign Collaborative Agreements for each supervised NP/PA. - Participate in weekly hospitalization review call and monthly team meeting. Who You Are Required Qualifications - Graduate of an accredited medical school - At least three years of post-residency clinical experience - Licensed to practice medicine in NY state within which the site is located - Must be Board Certified in Internal Medicine, Family Practice or Primary Care. - Must have current NY state and federal DEA certification - Current Certification in AHA or ARC Basic Life Support for health care providers is required - Demonstrated ability to collaborate with multi-disciplined clinicians - Ability to pass background check upon hire and throughout employment to include criminal felony & misdemeanor search, SSN validation/trace search (LEIE), education report (highest degree obtained), civil upper and lower search, 7-year employment report, federal criminal search, statewide criminal search, widescreen plus national criminal search, health care sanctions-state med (SAM), national sex offender registry, prohibited parties (OFAC) (terrorist watchlist), and a 10-Panel Drug Screen. Living our Values: - Serving everyone with compassion and leading with empathy. - Stepping up and creating value by taking charge and acting when there is an opportunity. - Adapting in a changing world by recognizing our responsibility to be agile and respond quickly. - Nurturing growth and belonging by respecting and celebrating everyone for who they are. Working Conditions: - High-speed internet service (cable or fiber optic) with minimum download Speed of 20 Mbps, Upload Speed of 5 Mbps, and Maximum Latency of 100 milliseconds (must be installed before starting) required. - Frequent use of computer and phone systems - Must be able to constantly remain in a stationary, sitting position, communicate and exchange information with others, inspect information, perform repetitive motions with arms and fingers, interpret data, problem solve, make decisions, organize and plan, and maintain a positive and professional attitude in all situations. - Work is performed from home with company-provided equipment. Sitting for long periods of time is expected and use of fingers and hands for typing is necessary. - A quiet workspace with minimal background noise for calls. - We encourage applicants from a variety of backgrounds and experiences to apply, especially those who can demonstrate how their unique qualifications and skills align with the requirements of this role and support our mission to improve whole-person health. This position will accept and review new applications and resumes no less than 5 business days after the original posting date and may remain open an extended period of time with no set end date based on the level of interest.

Role Description The Dayton Ohio VA Medical Center's Health Information Management Service is recruiting for a well-qualified Medical Records Technician - Coder Auditor. - Reviews, analyzes and reports performance monitors for PTF, PCE, VERA and Non-VA Medical Care (purchased care) coding. - Audits accurate and complete assignment of: - ICD-10-CM and ICD-10-PCS codes, MS-DRG, POA status, and discharge disposition values for inpatient health records. - ICD-10-CM, CPT, and HCPCS codes, including appropriate E/M assignment and modifier usage for outpatient health records. - Reviews coding and assists coders in improving coding accuracy; provides coding guidance to various levels of staff to promote consistency in practice and compliance with coding rules and regulations; initiates various reports and analyzes data. - Facilitates improved overall quality, completeness and accuracy of coded data. - Ensures the accuracy and completeness of clinical information used for measuring and reporting physician and medical center outcomes with continuing education to all members of the patient care team on an ongoing basis. - Responsible for performing audits of coded data, developing criteria, collecting data, graphing and analyzing results, creating reports and communicating in writing and/or in person to appropriate leadership and groups. - Collaboratively works with coding staff and clinical staff to provide support and education on coding issues; provides training and education to coding and clinical staff. - Researches complex coding issues and participates in process improvements related to coding. - Assists in the development of guidelines for data quality, consistency, and monitoring for compliance to improve the quality for clinical, financial, and administrative data. - As a technical expert in health information coding matters, provides advice and guidance on documentation and coding requirements. - Maintains current knowledge to ensure that coding and documentation meets regulatory guidelines and audit standards, and results in appropriate data capture and reimbursement. - Analyzes audit results and prepares summary feedback for individual coders and/or clinicians, making recommendations for improvement. - Provides coding consultation to coders and/or clinicians related to coding and documentation questions. - Maintains statistical databases to track the results and validate the program for identifying patterns and variations in coding practices with regular reports to the medical staff and management. Qualifications - United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. - Experience and Education: - One year of creditable experience that indicates knowledge of medical terminology, anatomy, physiology, pathophysiology, medical coding, and the structure and format of health records. - An associate's degree from an accredited college or university recognized by the U.S. Department of Education with a major field of study in health information technology/health information management, or a related degree with a minimum of 12 semester hours in health information technology/health information management. - Completion of an AHIMA approved coding program, or other intense coding training program of approximately one year or more. - Equivalent combinations of creditable experience and education are qualifying for meeting the basic requirements. - Certification: - Persons hired or reassigned to MRT (Coder) positions in the GS-0675 series in VHA must have either: - Apprentice/Associate Level Certification through AHIMA or AAPC. - Mastery Level Certification through AHIMA or AAPC. - Clinical Documentation Improvement Certification through AHIMA or ACDIS. Requirements - One year of creditable experience equivalent to the journey grade level of a MRT (Coder). - Employees at this level must have a mastery level certification. - Demonstrated Knowledge, Skills, and Abilities: - Advanced knowledge of current coding classification systems such as ICD, CPT, and HCPCS for the subspecialty being assigned. - Ability to research and solve complex questions related to coding conventions and guidelines in an accurate and timely manner. - Ability to review coded data and supporting documentation to identify adherence to applicable standards, coding conventions and guidelines, and documentation requirements. - Ability to format and present audit results, identify trends, and provide guidance to improve accuracy. - Skill in interpersonal relations and conflict resolution to deal with individuals at all organizational levels. Benefits - Competitive salary and regular salary increases. - 37-50 days of annual paid time off per year: - 13-26 days of annual leave. - 13 days of sick leave. - 11 paid Federal holidays per year. - After 12 months of employment, up to 12 weeks of paid parental leave in connection with the birth, adoption, or foster care placement of a child. - After 60 days of employment, full-time employees with a total family income below $144,000 may be eligible for a childcare subsidy up to 25% of total eligible childcare costs for eligible children up to the monthly maximum of $416.66. - Traditional federal pension - 5 years vesting - and federal 401K with up to 5% in contributions by VA. - Federal health/vision/dental/term life/long-term care insurance - many federal insurance programs can be carried into retirement.