RN Clinical Consultant

About the role

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.

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.

Requirements

• A highly motivated and reliable individual who can work with varying levels of supervision- independently or collaboratively.
• Detail-oriented and a decisive decision maker who can manage multiple priorities at the same time.
• 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.

Qualifications

• A minimum of 5 years in direct patient care settings.
• BSN and CCM preferred.

Skills

• Strong clinical background to understand and apply rationale of how injury or illness may impact the individual’s function.
• 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.
• Proactive contact with 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.
• Collaborate with internal vocational rehab specialists in identifying opportunities for return to work.
• 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.

Benefits

Not specified.

Pay

$70,340.00 - $115,565.00

Schedule

Not specified.

Location

Plano, TX, Bethlehem, PA, Holmdel, NJ, or fully remote

Travel

Occasional 0-10% of the time.

Notice Regarding Guardian’s Use of Artificial Intelligence in Recruitment

Guardian is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. Guardian also provides reasonable accommodations to qualified job applicants (and employees) to accommodate the individual's known limitations related to pregnancy, childbirth, or related medical conditions, unless doing so would create an undue hardship. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact MyHR@glic.com. Please note: this resource is for accommodation requests only. For all other inquires related to your application and careers at Guardian, refer to the Guardian Careers site.