Clinical Care Consultant

OneAmerica Financial•South Portland, ME

12d•$79,500 - $132,500•Hybrid

About The Position

The Clinical 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 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.
1-year clinical experience in claims organization preferred, but not required.

Nice To Haves

BSN preferred.

Responsibilities

Current with medial technology, conditions, treatments and expected recovery and prognosis of medical conditions. Maintains expertise to educate others and suggest process change when updates occur in the medical industry.
Conduct comprehensive clinical assessments of Long-Term Care, Life Waiver of Premium, Short- and Long- Term Disability claims.
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.
Provide support and training to the claims department around specific medical conditions and clinical trends to improve medical knowledge.
Document claim files and systems in a clear and professional manner.
Communicate effectively and professionally with a wide variety of peers and resources.
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.
Identify opportunities for process improvements.
Participate in projects, as needed, within the department.
Maintains a level of participation and commitment to OAs security, privacy and ethic policies.