Medicare Set-A-Side Nurse Allocator

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.
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Medicare Set-A-Side Nurse Allocator
PRIMARY PURPOSE OF THE ROLE: To provide professional assessment to prepare and draft complex Medicare Set-Asides (MSAs), Medical Cost Projections (MCPs), submission cases, and related products and acts as the liaison and internal resource regarding Centers for Medicare & Medicaid Services (CMS) guidelines.
? 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 nursing knowledge to create comprehensive medical reporting.
- 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
- Reviews medical claims and completes complex file review for Medicare Set- Asides (MSA) and future medical cost projections. (MCP).
- Applies clinical knowledge and expertise with established clinical guidelines and provide clients with accurate and timely reviews of clinical referrals and a comprehensive analysis of medical treatment.
- Utilizes claims, legal, and/or nursing knowledge to analyze medical records and creates clear, concise and thorough medical record summary identifying future medical treatment as documented in the medical records.
- Identify and document critical elements potentially impacting MSA cost projections for possible reduction or resolution.
- Utilizes resource data bases for diagnoses, treatment guidelines, and prescription medication pricing, documenting the MSA allocation when applicable and finalizes the MSA allocation including cost projections.
EDUCATION AND LICENSING
RN licensure required. Medicare Set-Aside Consultant Certified (MSCC) certification required. Bachelor's degree or equivalent from an accredited college or university preferred.
?TAKING CARE OF YOU BY
- Offering flexibility and autonomy.
- Supporting meaningful work that promotes critical thinking and problem solving.
- 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 including medical, dental vision, 401K, PTO and more beginning your first day.
?NEXT STEPS
If your application is selected to advance to the next round, a recruiter will be in touch.
#nurse #medicaresetaside #allocator #MSCC
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 $78,000 - $80,000. 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.

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.
Taking care of people is at the heart of everything we do. Caring counts
Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)