Clinical Reviewer

The Hartford•Hartford, CT

12h•Hybrid

About The Position

The Clinical Reviewer is responsible for assessing, planning, and evaluating medical treatment and return‑to‑work readiness through detailed review and analysis of medical and claim documentation. This role partners closely with claims professionals to support effective medical and disability management while ensuring high‑quality, timely, and cost‑effective claim outcomes.

Requirements

Active Registered Nurse (RN) license or comparable healthcare designation.
Minimum of three (3) years of clinical experience in one or more of the following areas: Orthopedics Neurology Rehabilitation Medical/Surgical Occupational Health
Customer‑focused approach with strong service orientation
Excellent analytical, critical thinking, and problem‑solving skills
Strong written and verbal communication abilities
Proficiency in Microsoft Office applications
Adaptability, innovation, and commitment to continuous improvement
Ability to build strong working relationships across teams

Nice To Haves

Bachelor’s degree in a health‑related field or equivalent relevant experience.
Prior critical care experience (e.g., Emergency Room or Intensive Care Unit).
Professional certifications such as CCM (Certified Case Manager) or CLCP (Certified Life Care Planner).

Responsibilities

Review, analyze, and document medical and claim information to develop clinical recommendations and action plans.
Provide clear clinical rationale and guidance to support claim handlers in managing medical and disability components of claims.
Assess medical complexity and determine appropriate treatment guidelines based on injury, comorbidities, and other contributing factors.
Establish projected disability durations and recovery expectations.
Manage clinical referrals and support services, including causation analysis and cost projections.
Collaborate with claims staff to promote optimal medical outcomes and timely return to work.