Senior RN Clinical Consultant, Disability Appeals

Guardian Life Insurance Company•Plano, TX

1d•Remote

About The Position

The Senior RN Clinical Consultant will partner with Clinical and Vocational Leaders to provide ongoing coaching and oversight to Clinical Consultants and serve as a clinical subject matter expert across all lines of business (STD/LTD/Appeals) and products, action planning management, and Guardian systems. This role emphasizes a strong clinical and client focus to ensure fair and accurate assessments of medically supported functional abilities. The incumbent will help cultivate talent and foster continuous learning, promoting organizational excellence through leadership and problem-solving. This individual will collaborate with the Clinical Team Manager to drive performance, ensure team goals are met, and effectively communicate departmental initiatives and changes aligned with organizational strategies. They will also assist the Clinical Team Manager in resolving issues related to clinical processes, claim management activities, customer inquiries, and quality. The ideal candidate is highly motivated, reliable, capable of working independently or collaboratively, diligent, and a decisive decision-maker who can prioritize multiple tasks with a positive attitude.

Requirements

A minimum of 3+ years of (STD, LTD, Appeals) claim experience
minimum of 2 years disability experience
A minimum of 5 years in direct patient care settings
RN REQUIRED
Demonstrated proficiency in verbal and written communication, as well as strong presentation abilities
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
Proven track record to mentor and coach
Proficiency in MS Word, Excel, PowerPoint, DCMS, Claim Facts, and iProcess

Nice To Haves

BSN and CCM preferred

Responsibilities

Train and mentor all new Clinical Consultants
Provide ongoing training, coaching and development to all Clinical Consultant members
Organize and present at least one Clinical Training session for the Claims teams over the course of a year
Work with Team Manager to delegate, distribute, and monitor workloads within the department to meet departmental regulations, improve efficiency and reduce or eliminate backlogs
Assist Team Manager when needed to monitor caseloads, productivity, and participate in calibration sessions with our Clinical CMA and provide feedback to leadership and team members
Oversee external vendor utilization within team
Leverage knowledge and skills to flex and assist the overall team meet its goals, (i.e., assist with STD/LTD/ Appeals, flex and assist if needed)
Collaborate with claims partners to resolve conflicts and establish procedures that promote clinical claim management accuracy and improved customer service
Address escalated customer inquiries and formal complaints
Senior BHCM will also be first point of contact for SI or mental health crisis calls
Support training initiatives by identifying knowledge gaps and providing ideas for improvement
Support Clinicians in developing efficient desk & time management skills
Collaborate with peers and leadership to ensure consistency with mentoring and coaching
Co-facilitate team meetings to share best practices, workflow changes, trends, and insights in alignment with Group benefits strategies
Provide desk coverage for leadership as needed