Clinical Care Consultant (Registered Nurse)

Preparing for the Future•South Portland, ME

5d•Hybrid

About The Position

The Clinical Care Consultant is responsible for supporting OneAmerica’s Claims operation acting both in a consultative nature during claim discussions and to provide comprehensive reviews of medical information. They are responsible for discussing and documenting an assessment of a claimant's potential for recovery and work function. Clinical Care Consultants also work closely with claims associates to educate regarding medical conditions, treatment, & recovery to function.

Requirements

Current & active Registered Nurse (RN) license in their state of residency required.
Clinical experience in acute care setting.
Ability to influence and teach others.
Use facilitation skills in a variety of discussions.
Work in a self-directed way being able to make independent judgments and decisions.
Prioritize and organize work independently while keeping the team and broader organizational needs in mind.
Strong research, analytical, critical thinking, problem solving skills and decision-making skills
Thrives in a fast-paced, service-oriented work environment with the need to pivot priorities according to needs of the business.
Computer skills with strong proficiency in Microsoft programs especially Word, Excel, Outlook email and Teams web-conferencing and messaging.
Selected employees must be able to perform the essential functions of the position satisfactorily and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions of their job, absent undue hardship.
Because this position is regulated by the Violent Crime Control and Law Enforcement Act, if an offer is made, applicants must undergo mandated background checks as a condition of employment. Such background checks include criminal history. A conviction is not necessarily an absolute bar to employment. Consistent with applicable regulatory guidelines and law, factors such as the age of the offense, evidence of rehabilitation, seriousness of violation, and job relatedness are considered.

Nice To Haves

BSN preferred.
Experience in a behavioral health setting preferred
2-5 years' clinical experience within claims organization preferred

Responsibilities

Conduct comprehensive clinical assessments of Short- and Long-Term Disability claims and Life Waiver of Premium.
Participate in multidisciplinary meetings as the clinical resource.
Provide answers regarding medical issues, and functionality.
Provide clear and complete clinical short and long-term clinical recommendations.
Assist claims associates with preparing information needed for peer reviews, IMEs, or FCEs by providing guidance around the specialty of provider to utilize and questions to ask of that provider.
Collaborate with internal resources to assist the claims team in developing a sound action plan for a claim.
Document claim files and systems in a clear and professional manner.
Communicate effectively and professionally with a wide variety of peers and resources.