Behavioral Health Consultant

Sun Life • Hartford, MA

1d • Hybrid

About The Position

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide. Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities. Job Description: Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. Our team members and leaders are expected to foster connection and teamwork by being present in the office at least 2 days per week. The Opportunity As a Behavioral Health Consultant within our Clinical Services team, you will apply your clinical expertise as a member of an interdisciplinary team that focuses on returning clients to optimal levels of productivity. This role does not involve hands-on assessment or direct care. All work is solely performed using electronic medical records and phone/fax communication. How you will contribute: The BHC plays a key role within that context to clarify functional capacity, treatment plan, and overall prognosis for return to work (RTW) through early interventions, such as provider contact, and other action planning with claims and vocational partners. As a BHC within our Clinical Services team, you will experience the benefit of a flexible work environment. Our focus is the quality of your work, not the quantity of the hours you spend in the office. We understand that life exists outside of work, and we want you to love your job and have the balance you need to enjoy your life outside of work.

Requirements

• LICSW active and unrestricted licensure, MSW preferred however, candidates with relevant experience may be considered or RN active and unrestricted licensure, BSN preferred; however, candidates with relevant experience may be considered
• Specialty certification such as C-ASWCM (Certified Advanced Social Work Case Manager), ASAM, CCM, CRRN, Psychiatric Mental Health Nursing, Forensic Nurse, LCPC/LPC or eligible with desire to pursue a plus
• Minimum of 3 years clinical experience working with an adult working age population
• Experience in a rehabilitation setting, psychiatric setting, Occupational Health, Case/Care Management, Disability Insurance, Group Benefits, or Workers compensation a plus
• Ability to communicate effectively and professionally with a wide variety of both internal and external Sun Life business partners, peers and resources.
• Attention to detail with documentation, reporting and communication.
• Facilitation skills in a variety of circumstances and with a wide variety of input. Ability to influence and teach.
• Self-directed with an ability to work independently and make independent judgments and decisions.
• Strong organizational skills, including the ability to prioritize work and multi-task.
• Strong research, analytical, critical thinking, problem solving skills and decision-making skills
• Ability and desire to work in a fast-paced, service-oriented environment
• Strong computer skills, proficient in PC environment and MS Word, Excel, and email systems
• A drive to continuously learn, build, and grow professionally
• Insurance claims experience is not a requirement

Responsibilities

• Conducts comprehensive behavioral health clinical assessments of disability claims that are referred in different venues
• Clarifies medical information and/or interprets medical reports (IMEs, hospital and office records, and health care provider’s (HCP) calls and letters) and evaluates restrictions and limitations to assess current and ongoing level of impairment.
• Synthesizes pertinent facts and answers questions in collaboration with claims professionals
• Meets standards set by management for quality and volume of work performed
• Applies current clinical knowledge to medical data regarding diagnosis, treatment, prognosis, and impairment
• Participates proactively through early assessment of medical issues, functional capacity, and RTW opportunities
• Determines what medical information is needed to evaluate function on an ongoing basis.
• Conducts analysis of medical information, including current treatment plan, provider opinion and either verbally or in writing documents rational for opinions and recommended next steps.
• Makes appropriate decisions and takes action as indicated to obtain additional medical information and/or referral to the appropriate resource, such as physician, claims professional, clinical or vocational resource
• Provides input and assistance to identify and collect pertinent medical information through outreach communications with attending physicians/health care providers, claimants/insureds, and employers
• Demonstrates excellent verbal and written communication to gather and report information, clarify restrictions and limitations, and assist with return to work
• Operates with urgency to support assigned claims professionals in effective and appropriate claim direction to identify and facilitate next steps and follow up needs on each individual claim file
• Makes contacts to insured, employer, and the HCP (health care provider) as indicated to understand symptoms, treatment, and impact on functional capacity.
• Coordinates with Vocational Rehabilitation Consultant (VRCs), nurses and others in regard to return-to-work services
• Evaluates each claim file for RTW opportunities and partners with the VRC to develop RTW plans as indicated
• Evaluates claims for potential accommodations or partial RTW
• Working with the VRC to identify functional capabilities for alternative occupations/job duties
• Provides consultation and education to peers and a variety of other constituents
• Demonstrates knowledge, skill, and problem solving in communicating effectively with both internal customers and with external resources
• Works collaboratively with clinical and claims professionals to improve disability claim management practices
• Provides clinical input in claims meetings and leads discussions to facilitate appropriate clinical intervention
• Provides training and mentoring to new clinical, vocational, claims, and other staff as appropriate.
• May provide training to groups of peers and/or claims professionals to update their knowledge/skills

Benefits

• At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program.
• Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account.
• Enjoy a flexible, inclusive and collaborative work environment that supports career growth.
• We’re proud to be recognized in our communities as a top employer.
• Proudly Great Place to Work® Certified in Canada and the U.S., we’ve also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1-10 employees