Overview
Are you interested in empowering and sustaining positive and measurable
differences in the health of individuals? Does the thought of joining a team of
exceptionally talented quality specialists inspire you? Do you enjoy using your
excellent analytical and writing skills to ensure client requirements are met by
the consistent, reliable execution of work? Do you thrive in performing audits
to ensure performance metrics are met and high-quality care is sustained? We
believe in helping those with work-sustained illnesses and injuries to live
their best life by providing case management and support to workers, providers,
employers, and claims staff.
As a Clinical Quality Management (QM) Specialist II, you will work remotely in
your home office from Monday to Friday, 8AM - 5PM Eastern Time and be
responsible for supporting the SGS Quality Management System and the activities
of the SGS Quality Improvement committees. This role involves supporting the
Clinical Operations teams to ensure compliance with QMS and client contracts.
The Clinical QM Specialist II identifies requirements and creates processes to
ensure consistent and reliable execution of work. They coordinate the creation
of controlled documents such as Standard Operating Procedures and Work
Instructions, perform audits to meet performance metrics, and address internal
and client concerns. Additionally, the Clinical QM Specialist II tracks and
mitigates risks, facilitates continual improvement by leading improvement
projects, and supports contract managers and the analytics team in preparing
quality assurance reports.
Clinical Quality Management Specialist II Responsibilities
* Supports the Clinical Operations Team serving as a clinical resource for all
program business units for quality assurance, clinical escalation and
training.
* Performs clinical document reviews, identifies deficiencies, errors and
collaborates with clinical professionals on remediation.
* Work with internal partners, such as Training, Program Management, Case
Management, Analytics, and Information Technology, to bring creative
solutions to meet corporate goals, and achieve client requirements.
* Work with external stakeholders and clients to ensure contract requirements
and program quality management activities are successfully carried out.
* Collaborate with SGS managers and teams regarding analysis, updates, and
recommendations for modifications for procedures and processes to continually
improve operations and protocols.
* Assist with the collection and summary of data in collaboration with SGS
Quality Committees, identify opportunities for improvement, and present
findings.
* Understands each contract's clinical quality assurance requirements and
monitors compliance, in collaboration with the SGS, clinical leadership,
analytics and management teams.
* Monitors and analyzes clinical outcomes in relation to goals and contractual
requirements, in collaboration with the SGS analytics and management team.
* Supports standard and ad hoc audits, as directed by clinical leadership
quality committees.
* Provides feedback and coordination of improvement of quality tools, such as
job aids, work instructions, and audit checklists.
* Assists in the identification of program deficits and coordinates team
training and monitoring of corrective actions.
* Deploys and oversees performance improvement activities.
* Tracks client complaints and issues to resolution, in collaboration with
Manager.
* Identifies new areas that need quality monitoring, on a short-term or
continuous basis.
* Assists in activities to prioritize improvement initiatives.
* Assumes responsibility for related duties as required or assigned.
Clinical Quality Management Specialist II Qualifications
* Associate’s Degree in Nursing (ADN) required; Bachelor’s degree in Nursing
(BSN), Healthcare, Health Administration or a related field preferred.
* Hold a current, active unrestricted Registered Nurse, licensed in any state,
Compact License Preferred.
* 5 years related clinical experience with a minimum of 2 years adult
medical/surgical nursing experience and a minimum of 2 years case management
experience in the workers’ compensation arena OR have a minimum of 1 year of
adult medical/surgical nursing experience and 3 years of case management
experience in the workers’ compensation arena.
* At least 2 years' experience with Quality Management including project
management, quality improvement, corrective action, auditing, and/or staff
education.
* Experience with Federal Employee Compensation Act (FECA) and FECA-related
issues preferable, as applicable.
* Nationally recognized Quality-related professional certification such as
Certified Professional Healthcare Quality or Six Sigma (preferred) OR
National certification in case management or related field preferred in one
of the following areas: Occupational Health (COHN); Case Management (CCM),
Insurance Rehabilitation (CIRS/CRRN), Disability Management (CDMS), and/or
Nurse Case Manager Board Certified (ANCC/ANA) preferred.
* Experience with quality-related certification/accreditation such as ISO
9001-2015 Quality Management System or URAC.
* Experience in Workers' Compensation, Disability Management, or related
industrial health environment (preferred).
* Ability to pass a preliminary credit and background check.
For a career path that is both challenging and rewarding, join Sedgwick
Government Solution’s talented team. Taking care of people is at the heart of
everything we do. Our clients depend on our talented colleagues to take care of
their most valuable assets—their employees, and their customers. At Sedgwick
Government Solutions, caring counts®. Join our team of creative and caring
people of all backgrounds and help us make a difference in the lives of others.
Sedgwick Government Solutions 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 a specific
location. For the jurisdiction noted in this job posting only, the range of
starting pay for this role is ($63K-$80K). 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.
To be considered for this position, please submit a resume, and complete the
application.
The information provided above has been designed to indicate the general nature
and level of work of the position. It is not a comprehensive inventory of all
duties, responsibilities, and qualifications required.
Important Information
Successful candidates will be required to undergo a financial and criminal
background check and obtain and maintain confidential-level security clearance
upon hire. We participate in the United States Federal Government E-Verify
program to confirm the employment authorization of the employee upon hire.
Search Firm Representatives
Please be advised that Sedgwick Government Solutions is not seeking assistance
or accepting unsolicited resumes from search firms for this employment
opportunity. Regardless of past practice, a valid written agreement and task
order must be in place before any resumes are submitted to Government Solutions.
All resumes submitted by search firms to any employee at Government Solutions
without a valid written agreement and task order in place will be deemed the
sole property of Government Solutions and no fee will be paid in the event that
person is hired by Government Solutions.
Government Solutions strives to make our career site accessible to all users. If
you need a disability-related accommodation for completing the application
process, please contact Government Solutions regarding accommodations.
Sedgwick Government Solutions is an Equal Opportunity and Affirmative Action
Employer
All qualified applicants will receive consideration for employment without
regard to age, citizenship status, color, disability, marital status, national
origin, race, religion, sex, sexual orientation, gender identity, veteran
status, or any other classification protected by federal state or local laws as
appropriate, or upon the protected status of the person’s relatives, friends or
associates.
Sedgwick Government Solutions abides by the requirements of41 CFR 60-741.5(a)
[http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf]. This
regulation prohibits discrimination against qualified individuals on the basis
of disability and requires affirmative action by covered prime contractors and
subcontractors to employ and advance in employment qualified individuals with
disabilities.
Sedgwick Government Solutions abides by the requirements of41 CFR 60-300.5(a)
[http://www1.eeoc.gov/employers/upload/eeoc_gina_supplement.pdf]. This
regulation prohibits discrimination against qualified protected veterans and
requires affirmative action by covered prime contractors and subcontractors to
employ and advance in employment qualified protected veterans.
About Sedgwick Government Solutions
Sedgwick Government Solutions is a trusted partner for federal agencies across
the U.S., helping them confidently manage risk and claims. With decades of
experience and deep regulatory expertise, we keep agencies compliant while
improving their workforces’ health and productivity. Backed by the most advanced
technology, our tailored solutions help agencies navigate the complexities of
federal risk and claims management.Sedgwick Government Solutions
[https://www.sedgwickgovernment.com/]S
Sedgwick Government Solutions