RN Medicare Compliance – Proactive Reduction Outreach

Sedgwick

Clinical assessment role performing Medicare Set-Aside allocations at Sedgwick. Engaging with providers for documentation and analysis while maintaining compliance and quality standards.

Posted 5/12/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $60,000 - $65,000 per yearWebsite

About the role

Key responsibilities & impact

To perform initial and ongoing clinical assessment through provider outreach, specialized document review, and analysis and interpretation of interventions for the preparation of Medicare Set-Aside allocations.
Contacts providers and attorneys to obtain clarification of documentation needed to support the preparation of Medicare Set-Aside allocations.
Uses specialized knowledge to assess the needs of the individual case and creates customized correspondence for any applicable providers.
Proactively and strategically plans and executes outreach activities with providers via telephone, email, and fax.
Reviews and analyzes completed documentation from providers.
Measures interventions to determine the outcome of the clinical assessment involvement.

Requirements

What you’ll need

Bachelor's degree from an accredited college or university preferred.
Active unrestricted RN license issued in a state or territory of the United States required.
Four (4) years of related experience or equivalent combination of education and experience required.
Excellent oral and written communication skills, including presentation skills.
PC literate, including Microsoft Office products.
Analytical and interpretive skills.
Strong organizational 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.

Benefits

Comp & perks

Three Medical, and two dental plans to choose from.
Tuition reimbursement eligible.
401K plan that matches 50% on every $ you put in up to the first 6% you save.
4 weeks PTO your first full year.

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical assessmentMedicare Set-Aside allocationsdocument reviewanalysis and interpretationoutreach activitiesreport writingintervention measurement

Soft Skills

oral communicationwritten communicationpresentation skillsanalytical skillsinterpretive skillsorganizational skillsteamworkperformance competency

Certifications

RN license