Claims Psychiatric Consultant

Northwestern Mutual

14d

About The Position

Provide technical support to the Claims Department in the evaluation of psychiatric claims. Serve as liaison between the Claims staff and all physician constituents, both within and outside of Northwestern Mutual, for psychiatric aspects of claims. Advocate the Company's psychiatric position on claims and resolve disputes on the psychiatric aspects of them. Monitor and continually improve protocols for the psychiatric management of claims.

Requirements

• Minimum of a Master's Degree in Social Work or Master's Degree in Psychology
• Current LCSW or LPC state license
• Minimum of 5-7 years of clinical mental health experience
• Excellent interpersonal skills and proven ability to work effectively with others at all experience levels
• Superior written and verbal communication skills.
• Strong analytical skills and proven ability to exercise sound judgment and decision-making skills.
• Demonstrated leadership ability
• Knowledge of computer functions and experience in a Windows environment.

Nice To Haves

• Teaching experience in a staff development role, unit management experience or other equivalent responsible professional/administrative experience.
• Knowledge of disability insurance or prior experience in insurance claim management preferred.

Responsibilities

• Provide expert psychiatric technical support to the Claims Department in order to ensure the timely and consistent review of the psychiatric components of claims through evaluation of medical records (Attending Physician Statements, treatment records, test results, Evaluative Medical Examination (EME) reports, and Paper Review reports), provide opinions to Claim analysts, and identify when additional information is needed.
• Identify the need for and coordinate the handling of claim referrals to psychiatric staff or to EME/Paper Review physicians, and act as the liaison between the Claims Department and all psychiatric resources psychiatric consultants, EME physicians, and other outside psychiatric experts to ensure that psychiatric reviews are thorough and complete and adhere to the claim philosophy of the Claims Department. Triage and review all psychiatric cases being referred to Psychiatric Experts to determine level of review required.
• Communicate with and advocate Company's position to attending physicians and physician insureds regarding insured's psychiatric condition, clinical findings, significance of and support for claimed limitations, appropriateness of treatment and alternatives, expected duration of claim, and potential for rehabilitation or return to work in order to assist the Claims Department in expediting their psychiatric reviews and providing the expected levels of customer service. Resolve psychiatric disputes, via negotiation and/or participation in litigation.
• Research, create and present all psychiatric education and training for the Claims Department and provide new analyst psychiatric training classes and prepare periodic presentations to help ensure efficiency and consistency in administering psychiatric claim protocols and processes.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level