RN Clinical Consultant, Claims Shared Services

Fully Remote

Remote – United States

Full time

R000105501

Position Summary

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 disability claims. The RN Clinical Consultant identifies restrictions, limitations and duration impacting functional capacity based on medical data, to assist the Claim Managers in determining claim liability. The RN 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.

Candidate Responsibilities

The RN Clinical Consultant reviews long-term disability claims to determine the impact of claimants’ medical condition on their function as well as the impact of their medical treatment in achieving improved functional outcomes. They must possess a strong clinical background to understand and apply rationale of how injury or illness may impact the claimant’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. The RN Clinical Consultant works collaboratively with internal vocational rehab specialists in identifying opportunities for return to work. They work to proactively identify and resolve customer issues, when possible, to enhance the customer experience.

Activity

Review and assess claimant subjective reports and objective medical evidence to determine the impact of medical conditions on function. Clarify medical information, interpret medical reports, and evaluate restrictions and limitations to assess current and ongoing level of impairment. Apply current medical knowledge regarding diagnosis, treatment, prognosis, and impairment. Participate proactively through early assessment of medical issues, work capacity and RTW opportunities.

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. Plan for ongoing case management through proactive partnering with treating providers to move claimants toward appropriate care.

Proactively contact claimants to obtain information about their condition and impact on work and daily living as part of ongoing assessment of medical condition. 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 the claim. 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.

Provide consultation with peers. Work collaboratively with vocational rehab specialists to identify opportunities for return-to-work services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals.

Utilization of 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. Follow best practices for developing reviews and sharing feedback with treating providers.

Demonstrate diplomacy and professional competency through interactions with medical providers, claim staff, and peers and display empathy and a focus on customer service in all interactions.

Manage case load efficiently, organize priorities, provide timely intervention, and implement continuous quality process improvement.

Reporting Relationships

As our RN Clinical Consultant, the incumbent will report to our Team Leader of LTD Clinical Services, who reports to our Head of LTD Claims

Candidate Qualifications

Functional Skills

Competencies/Skills:

Excellent written and verbal communication skills.
Ability to exercise independent and sound judgement in decision-making.
Excellent organizational and time management skills.
Must have ability to multi-task with the ability to manage work based on continually changing priorities.
Display self-motivation and be able to work independently.
Ability to work collaboratively with multiple professional disciplines and diverse populations.
Detail oriented.
Excellent information research skills.

Leadership Behaviors

In addition to the above requirements, a candidate for this position must lead by example and demonstrate the following behaviors (including but not limited to):

Uphold Guardian’s commitment to ethical business practices.
Continuously strive to provide superior products and customer service.
Establish and maintain collaborative relationships that are mutually respectful.

Position Qualifications

RN from an accredited school of Nursing with a valid nursing license in good standing.
Proficiency in multiple computer systems required.
CCM preferred.

Experience:

Minimum of 5 years of clinical nursing experience, with at least 2 of those years within an acute care setting.
Disability experience strongly preferred.

Location

Remote

Travel

Less than 10% of travel required for this role.

Salary Range

$0.00 – $0.00

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.

Our Promise

At Guardian, you’ll have the support and flexibility to achieve your professional and personal goals. Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.

Inspire Well-Being

As part of Guardian’s Purpose – to inspire well-being – we are committed to offering contemporary, supportive, flexible, and inclusive benefits and resources to our colleagues.

Health Care

Choice of [high deductible/copay] medical plans* with prescription drugs, including coverage for fertility and transgender inclusive benefits
Dental plan
Vision plan
Health care accounts – flexible spending, health reimbursement, and health savings accounts
Critical illness insurance

Life and Disability Insurance

Company-paid Life and Disability insurance plus voluntary supplemental coverage
Accident insurance

Retirement and Financial

401(k) retirement plan with a company match, plus an annual age/service-based Company contribution and an annual profit-sharing contribution, if applicable
Complimentary 1:1 financial guidance with a licensed Fidelity representative

Time Off and Remote Work

Flexible work arrangements (part in-person/part remote)
Unlimited paid time off for most roles plus time off for volunteering, jury duty, voting, and bereavement
Personal holidays for colleagues to use in recognition of religious, cultural, or civic days
Paid parental leave and paid family and medical leave policies

Emotional Well-being and Work-Life

Emotional well-being, mental health, and work/life resources powered by Spring Health
Wellness programs, including fitness program and equipment reimbursement
Child, adult, and elder back-up care support through Bright Horizons
Adoption assistance
College planning
Tuition reimbursement
Student loan assistance
Commuter benefits in select metropolitan areas

Equity & Inclusion

Opportunities to build inclusive and meaningful connections through involvement in colleague-led affinity groups:

Employee Resource Groups:
Colleague Connection Committees
Community Involvement Committees

A culture that encourages colleagues to bring their authentic selves to work

Voluntary self-ID
Pronunciation and phonetic spelling of names

Benefits apply to full-time eligible employees. Interns are not eligible for most Company benefits.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 applicant_accommodation@glic.com.

Current Guardian Colleagues: Please apply through the internal Jobs Hub in Workday.

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RN Clinical Consultant, Claims Shared Services