Professional Liability Nurse Consultant II
CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice designation. Come be a part of our team and "Claim Your Future."
PRIMARY PURPOSE: To handle complex or high exposure claim issues; to provide medical knowledge of the health care system and health care issues; to independently investigate, analyze and evaluate medical malpractice claims for self-insured and commercially insured clients; to provide information needed to clients as needed to determine liability issues and exposure; and to assist in identification of risk management issues to decrease liability exposure and associated legal costs.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- Handles complex or high exposure claim issues; advises and leads Professional Liability Nurse Consultant I colleagues.
- Receives requests for investigation; reviews and develops action plans and investigates cases accordingly.
- Collects data from Company and clients to document and communicate results as appropriate.
- Prepares reports summarizing medical records and interviews; outlines issues related to summary reports; and provides analysis and recommendations for further claims handling.
- Interviews practitioners involved in medical malpractice claims at hospital facilities weekly as needed.
- Participates in follow-up review and investigation as directed and assists in discovery requests as needed.
- Maintains a quality assurance program to support the total performance management initiative and the consistent delivery of quality claims service.
- Travels as required.
QUALIFICATIONS
Education & Licensing
Baccalaureate degree from an accredited college or university preferred. RN license required. LNC (Legal Nurse Consultant) Certification or training preferred.
Experience
Five (5) years related clinical nursing experience and two (2) years nurse consultant experience required. General or Professional Liability investigation related experience preferred.
Skills & Knowledge
- Technical claims knowledge of medical malpractice claims procedures and practices
- Excellent oral and written communication, including presentation skills
- PC literate, including Microsoft Office products
- Analytical and interpretive 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.
Sedgwick CMS is an Equal Opportunity Employer
and a
Drug-Free Workplace