RN Clinical Consultant: Disability Claims & RTW

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. You are A highly motivated and reliable individual who can work with varying levels of supervision- independently or collaboratively. You are detail‑oriented and a decisive decision maker who can manage multiple priorities at the same time. You have 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 You will 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. Location Plano, TX, Bethlehem, PA, Holmdel, NJ, or fully remote Travel Occasional 0-10% of the time. Salary Range $68,970.00 - $113,310.00 The salary range reflected above is a good faith estimate of base pay for the primary location of the position. The salary for this position ultimately will be determined based on the education, experience, knowledge, and abilities of the successful candidate. In addition to salary, this role may also be eligible for annual, sales, or other incentive compensation. Equal Employment Opportunity Guardian is an equal opportunity employer. All qualified applicants will be considered for employment without regard to age, race, color, creed, religion, sex, affectional or sexual orientation, national origin, ancestry, marital status, disability, military or veteran status, or any other classification protected by applicable law. Accommodations 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 View email address on click.appcast.io. Please note: this resource is for accommodation requests only. For all other inquiries related to your application and careers at Guardian, refer to the Guardian Careers site. Visa Sponsorship Guardian is not currently or in the foreseeable future sponsoring employment visas. In order to be a successful applicant, you must be legally authorized to work in the United States, without the need for employer sponsorship. #J-18808-Ljbffr Guardian Life