Nurse Disability Consultant
About The Position
The Nurse Disability Consultant reviews, analyzes, and interprets medical information associated with disability claims. Serving as a clinical resource to Group Protection benefit specialists and claim professionals, the consultant evaluates diagnoses and condition severity, validates medical restrictions and limitations, and estimates recovery duration. The role also provides coaching and guidance to claims professionals on medical management. The consultant collaborates with claims staff, physician consultants, health care providers, and Vocational Rehabilitation Coordinators to support claim decisions and return-to-work services. The position is remote for employees residing outside a commutable distance to an office location.
Requirements
- Bachelor's degree in Nursing or equivalent work experience, with four years of experience in lieu of a bachelor's degree.
- Current, unrestricted Registered Nurse license in the state where the position is located, required upon hire.
- Ability to read, analyze, and interpret internal and external documents, including professional publications, technical procedures, regulations, policies, proposals, and standard operating procedures.
- Strong written and verbal communication skills.
- Ability to communicate clearly and concisely when interpreting medical information, documenting clinical rationales, clarifying restrictions and limitations, supporting return to work, and communicating with staff, management, and other stakeholders.
Nice To Haves
- Associate's or bachelor's degree in Nursing.
- Three to five years of nursing experience, preferably with clinical expertise in emergency room, critical care, orthopedics, coronary care, or trauma.
- Previous insurance industry experience.
- Experience or proficiency in disability management (STD/LTD), workers' compensation, utilization review, or nurse case management.
Responsibilities
- Maintain knowledge of current and emerging developments and trends, assess their impact, and collaborate with management to incorporate them into current and future solutions.
- Evaluate medical information to clarify diagnoses, assess condition severity, validate medical restrictions and limitations, and estimate recovery duration.
- Interpret and evaluate medical information to assess the appropriateness of current and ongoing restrictions, limitations, and impairment levels.
- Identify pertinent clinical facts and answer questions in collaboration with benefit specialists and physician consultants.
- Serve as a clinical resource to Group Protection claim professionals during claim meetings and as needed.
- Recommend medical information needed to evaluate ongoing impairment and facilitate optimal claim management.
- Refer claims to external clinical resources, including independent medical examinations, functional capacity evaluations, and peer reviews, as appropriate.
- Discuss complex medical issues with health care providers as needed and document the outcomes.
- Coordinate with Vocational Rehabilitation Coordinators and others to support return-to-work services.
- Manage assigned caseload within department productivity goals.
Benefits
- PTO and parental leave.
- Competitive 401(k) and employee benefits.
- Free financial counseling, health coaching, and employee assistance program.
- Tuition assistance program.
- Flexible work arrangements.
- Leadership development and virtual training opportunities.
- Effective productivity and technology tools and training.
- The role may be eligible for a discretionary Annual Incentive Program and may include long-term incentives or sales incentives.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
