Clinical Quality Management Specialist II (Remote) 2025-1419

Sedgwick Government Solutions is a fully owned subsidiary of Sedgwick. Sedgwick is a leading global provider of technology-enabled risk, benefits, and integrated business solutions. Taking care of people is at the heart of everything we do. Millions of people and organizations count on Sedgwick each year to take care of their needs when they face a major life event or something unexpected happens. The company provides a broad range of resources tailored to clients' specific needs in casualty, property, marine, benefits, and other lines. At Sedgwick, caring counts; through the dedication and expertise of more than 27,000 colleagues across 65 countries, the company takes care of people and organizations by mitigating and reducing risks and losses, promoting health and productivity, protecting brand reputations, and containing costs that can impact the bottom line. www.sedgwick.com Privacy | Sedgwick Terms and Conditions | Sedgwick

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.

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.