RN Clinical Consultant

Guardian Life Insurance

2d•$68,970 - $113,310•Remote

About The Position

Guardian is seeking an RN Clinical Consultant to serve as a clinical expert supporting the evaluation of short-term and long-term disability claims. In this role, you will analyze medical information, assess functional capacity, collaborate with healthcare providers, and provide clinical guidance that supports claim decisions. You will play a critical role in enhancing customer outcomes through sound clinical judgment, proactive case collaboration, and a commitment to exceptional service. This role requires a highly motivated and clinically skilled registered nurse who thrives in a fast-paced, customer-focused environment. You can work independently while also collaborating effectively with claim professionals, healthcare providers, vocational specialists, and internal business partners. You are analytical, detail-oriented, and decisive, with the ability to evaluate complex medical information and translate clinical findings into actionable recommendations. You act with urgency and accountability while maintaining a strong commitment to improving claimant outcomes and customer experiences.

Requirements

Active Registered Nurse (RN) license
Minimum of 5 years of direct acute patient care experience
Minimum of 3 years' experience as a clinical consultant in LTD and/or STD (LTD preferred)
Strong knowledge of medical conditions, treatments, and their impact on functional capacity and disability duration
Excellent verbal and written communication skills
Strong clinical assessment, analytical, critical thinking, and research skills
Ability to exercise independent judgment and make sound clinical decisions
Strong organizational and time-management skills with the ability to prioritize competing demands
Proficiency with Microsoft Office applications, including Word, Excel, and PowerPoint
Ability to adapt to changing business needs and work effectively in a dynamic environment
Must be legally authorized to work in the United States, without the need for employer sponsorship/support now or at any time in the future.

Nice To Haves

Bachelor of Science in Nursing (BSN)
Certified Case Manager (CCM) designation
Experience supporting disability, absence management, or insurance-based claims operations
Knowledge of disability products, business rules, and claims procedures
Experience with DCMS, Claim Facts, iProcess, or similar claims management systems

Responsibilities

Review short-term and long-term disability claims to evaluate medical documentation, functional limitations, treatment progress, and expected recovery timelines.
Analyze the impact of illness, injury, and treatment plans on a claimant’s ability to perform occupational and daily living activities, providing clinical recommendations that support claim decisions.
Collaborate with treating providers, claimants, case managers, and vocational rehabilitation specialists to promote appropriate treatment plans, clarify medical information, and facilitate return-to-work opportunities.
Serve as a clinical subject matter expert by educating claims professionals on medical conditions, treatment interventions, functional impairments, and disability-related outcomes.
Coordinate independent medical reviews and assessments, ensuring quality, accuracy, and timely resolution of complex clinical questions.
Manage a high-volume workload while prioritizing customer needs, resolving issues proactively, and supporting continuous quality improvement initiatives.
Provide ongoing mentoring and training to claims staff and peers regarding the medical and functional impact of injury, illness, and treatment on disability claims.