RN Clinical Consultant

Guardian Life Insurance

4d•Hybrid

About The Position

The RN Clinical Consultant serves as a clinical resource for the investigation and assessment of medical information regarding disability by providing comprehensive medical reviews and analysis of long-term and or short-term disability claims. The Clinical Consultant identifies restrictions, limitations and duration impacting functional capacity based on medical data, to assist the Case Managers in determining claim liability. The Clinical Consultant collaborates with treating providers to assist individuals to obtain appropriate care and ensure optimal treatment outcomes and acts with urgency and ownership to resolve customer issues and prioritize the customer experience.

Requirements

A minimum of 5 years in direct patient care settings
BSN and CCM preferred
Excellent verbal and written communication skills and presentation skills
Ability to exercise independent & sound judgment in decision making
Strong problem-solving, analytical, clinical, and information research skills
Excellent time management & organizational skills
Demonstrated ability to multi-task with the ability to manage continually changing priorities and the ability to prioritize work based on customer service needs and departmental regulations
The ability to remain flexible due to changing business needs
Strong knowledge of medical conditions and how they apply to disability products
Professional oral, written and presentation skills
Strong PC skills, including Microsoft Office applications (MS Word, Excel, PowerPoint)
Knowledge of disability products, business rules and procedures, preferred
Experience with DCMS, Claim Facts, and iProcess preferred
Must be legally authorized to work in the United States, without the need for employer sponsorship.

Nice To Haves

BSN and CCM preferred
Knowledge of disability products, business rules and procedures, preferred
Experience with DCMS, Claim Facts, and iProcess preferred

Responsibilities

Review long-term and or short-term disability claims to assess the impact of claimants’ medical condition on their function as well as the impact of their medical treatment in achieving improved functional outcomes.
Possess a strong clinical background to understand and apply rationale of how injury or illness may impact the individual’s function.
Possess excellent verbal and written communication skills to gather and report information accurately, ask appropriate questions to facilitate partnership with treating providers, claimants, and internal partners to encourage participation of claimant in appropriate treatment goals.
Conduct analysis of claimant’s current treatment plan and collaborate with health care providers and claimants to promote accountability for the appropriateness and status of treatment plan and length of disability.
Proactively contact treating providers to discuss treatment plans and clarify treatment and RTW goals.
Educate providers and claimants on the positive impact of return to work to ensure improved functional status and medical outcomes.
Serve as a technical resource on the medical aspect of long-term and or short-term disability claims.
Identify opportunities to educate claim staff and peers on medical aspect of disability.
Provide ongoing training and mentoring to claims staff and peers regarding issues impacted by the nature of injury or illness and its impact on function in work or daily activities.
Work collaboratively with internal vocational rehab specialists in identifying opportunities for return to work.
Work to proactively identify and resolve customer issues, when possible, to enhance the customer experience.
Utilize independent vendors to perform independent medical assessments. Specifically define issues to be addressed or clarified by outside physician or provider and oversee quality of review.
Manage workflow efficiently, organize priorities, provide timely intervention, and implement continuous quality process improvement.