Case Coordinator

• Manage complex cases in the community across child-serving systems
• Conduct comprehensive evaluations of referred members’ needs and eligibility
• Evaluate benefit plans and internal and external programs/services
• Identify high-risk factors and service needs and make appropriate referrals
• Coordinate and implement assigned care plan activities
• Monitor care plan progress
• Consult with case managers, supervisors, Medical Directors, and health/behavioral health programs to overcome barriers
• Present cases at case conferences for multidisciplinary review
• Collaborate with members’ Child and Family Teams
• Identify and escalate quality-of-care issues
• Negotiate appropriate options and services to meet members’ benefits and healthcare needs
• Use motivational interviewing to promote member engagement and behavior change
• Provide coaching, information, and support for independent medical and healthy lifestyle choices
• Help members participate knowledgeably in healthcare decisions with providers
• Serve as a single point of contact and remediate immediate gaps in care and access
• Apply case management and quality management processes in compliance with regulatory, accreditation, and company requirements

Case Management Coordinator, Field

• Conduct comprehensive evaluations of referred members’ needs and eligibility
• Evaluate benefit plans and internal and external programs/services
• Identify high-risk factors and service needs and make appropriate referrals
• Coordinate and implement assigned care plan activities and monitor progress
• Consult with case managers, supervisors, Medical Directors, and health/behavioral health programs to overcome care barriers
• Present cases at case conferences for multidisciplinary review
• Collaborate with members’ Child and Family Teams
• Identify and escalate quality-of-care issues
• Negotiate appropriate options and services to meet member benefits and healthcare needs
• Use motivational interviewing to maximize member engagement and promote healthy behavior changes
• Provide coaching, information, and support for independent medical and healthy lifestyle choices
• Help members participate knowledgeably in healthcare decision-making with providers
• Serve as a single point of contact and remediate immediate gaps in care and access
• Use case management and quality management processes in compliance with regulatory, accreditation, and company requirements

Case Management Coordinator – Field

• Provide excellent customer service and internal support to an assigned team
• Manage workers’ compensation claims caseload under supervision and in collaboration with the Clinical Case Management Team
• Collect and document data for workers’ compensation claims while following workflow and company guidelines
• Process and facilitate necessary treatment services according to company policy and procedure
• Verify return-to-work and remain-at-work status through routine communication with claim parties and documentation in the claim management system
• Use telephonic and written communications to accurately report return-to-work dates
• Maintain knowledge of Bureau of Workers’ Compensation rules and laws, workers’ compensation processes, and Sedgwick policies and procedures

• Provide excellent customer service and internal support to an assigned team
• Manage workers’ compensation claims caseload under supervision and in collaboration with the Clinical Case Management Team
• Collect and document data for workers’ compensation claims
• Process and facilitate necessary treatment services according to company policy and procedure
• Verify return-to-work and remain-at-work status through communication with claim parties and documentation in the claim management system
• Use telephonic and written communications to accurately report return-to-work dates
• Maintain knowledge of Bureau of Workers’ Compensation rules and laws, workers’ compensation processes, and Sedgwick policies and procedures