Medical Director, Occupational Health – Workers’ Compensation Managed Care

Job not on LinkedIn

🕒 June 16

🇺🇸 United States – Remote

💵 $300k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 55%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Sedgwick

WebsiteLinkedInAll Job Openings

10,000+ employees

🏗️ Construction

💼 Consulting

🏥 Healthcare

Construction • Consulting • Healthcare

Sedgwick is a global provider of technology-enabled risk, benefits, and integrated business solutions. They help people and organizations by managing and mitigating risk with solutions in accident, health, disability, unemployment compensation, and liability claims administration, among others. Sedgwick offers services such as claims administration, building consulting, forensic accounting, and forensic engineering. Their specialties include property restoration, brand protection, and loss prevention across several industries, including agriculture, construction, and environmental sectors. The company emphasizes diversity, equity, and inclusion (DEI) as well as environmental, social, and governance (ESG) practices.

📋 Description

• Evaluate medical reports escalated due to deficient information using evidence-based criteria • Provide leadership to clinician and claim professionals through training and implementation of medical best practices • Provide client-facing support for ADAAA and FMLA services requiring medical expertise • Stay current on medical trends, treatment standards, clinical literature, and evidence-based guidelines • Participate in client stewardship discussions, claim roundtables, and complex medical escalations • Support workers’ compensation, disability, FMLA, fitness-for-duty, return-to-work, liability, and safety-sensitive workforce issues • Support utilization review, physician advisor activities, care management strategy, vendor alignment, and quality improvement • Obtain and maintain Medical Director licensure in select states as needed • Apply clinical guidelines and medical literature to recommendations, claim discussions, treatment-plan clarification, and return-to-work/disability decisions • Engage treating providers and support appeals, independent medical review considerations, peer review alignment, and clinical quality review • Conduct reviews for treatment-plan clarification, claim denial, disability certification, and duration management • Call treating physicians to discuss facts and evidence for claim determinations • Document recommendations in Juris and SharePoint within required time frames • Oversee appeal and review processes and recommend specialties for Independent Medical Review • Develop and deliver training materials and presentations • Provide guidance and leadership to client-dedicated leadership teams and team leads • Ensure compliance with policies, best practices, service standards, regulations, and client requirements • Coordinate and evaluate service delivery among the company, partners, and vendors • Serve on a client Disability Pension Board and review appeal cases for quality assurance • Vote on eligibility determinations and attend quarterly meetings telephonically or virtually • Provide MRO expertise and occupational health assistance in escalated cases • Collaborate across the company and perform other assigned duties • Support quality programs • Supervise, guide, motivate, hire, and develop colleagues; administer personnel policies and conduct performance discussions • Travel as required

🎯 Requirements

• Medical Doctor (M.D.) degree required • Ten (10) years of related experience required • One (1) to three (3) years utilization review experience • Three (3) years clinical quality control experience • Knowledge of evidence-based guidelines • Knowledge of ADAA and FMLA • Knowledge of utilization review procedures • Knowledge of clinical quality systems and measurements • Knowledge of regulations and parameters of third party reimbursement, benefit determinations and payments • Knowledge of statutory requirements of state jurisdictions and ERISA regulations • Knowledge about general claim practices • Excellent oral and written communication skills, including presentation skills • PC literate, including Microsoft Office products • Analytical and interpretive skills • Strong organizational skills • Excellent interpersonal skills • Proven management/leadership skills • Ability to create and complete comprehensive, accurate and constructive written reports • Ability to work in a team environment • Ability to meet or exceed Performance Competencies • Travel expectations of 25%-30% • Experience with insurance carriers, TPAs, or managed care organizations extremely helpful • Knowledge of pharmacy processes and pharmacy benefit management a plus • Understanding of pain management a plus

🏖️ Benefits

• Blended work environment • On-going learning and professional growth opportunities • Three medical plans • Two dental & vision plans to choose from • Tuition reimbursement • 401K plan that matches 50% on every $ you put in up to the first 6% you save • 4 weeks PTO your first full year • Disability and life insurance • Employee assistance • Flexible spending or health savings account • Other additional voluntary benefits • Work-life balance • Strong team environment and culture of support