Key Facts

Remote From:

Freelance

Senior (5-10 years)

English

Hard Skills

Nurse Registry Disability Claims Medical Record Management Disability Management Clinical Informatics Clinical Informatics Basic Patient Care Process Management Return-to-Work Management Case Management Systems +4 more

Other Skills

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Microsoft Excel
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Microsoft PowerPoint
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Microsoft Word
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Non-Verbal Communication
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Adaptability
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Analytical Skills
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Multitasking
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Time Management
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Teamwork
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Organizational Skills
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Detail Oriented
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Prioritization
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Problem Solving

Roles & Responsibilities

Minimum of 5 years in direct patient care settings
BSN and CCM preferred
Excellent verbal and written communication and presentation skills
Strong PC skills, including Microsoft Word, Excel, PowerPoint

Requirements:

Review long-term and/or short-term disability claims to assess the impact of claimants' medical condition on their function and the impact of their medical treatment on functional outcomes.
Conduct analysis of claimants' current treatment plan and collaborate with health care providers and claimants to promote accountability for the appropriateness and status of the treatment plan and length of disability.
Proactively contact treating providers to discuss treatment plans and clarify return-to-work goals, educating providers and claimants on the positive impact of return to work on functional status and medical outcomes.
Serve as a technical resource on the medical aspect of long-term and/or short-term disability claims and provide ongoing training and mentoring to claims staff and peers on medical aspects and their impact on function in work or daily activities.

Guardian Life

Financial Services

About Guardian Life

Who we are Guardian makes a difference in the lives of people when they need us most. With over 160 years of stability and fiscal integrity, we are a trusted resource to generations of families and business owners, inspiring well-being and helping build financial confidence. Today, we stand behind 29 million consumers, helping them prepare and plan for a bright future for themselves and their families. We help business owners care for their employees. And we help people recover and thrive in times of unexpected loss. As a modern mutual insurance company, we believe in driving value beyond dividends. We invest in our colleagues and are building a progressive, innovative and inclusive culture. We uplift individuals and communities through thoughtful social and environmental programs. What we stand for In 1860, a community of immigrants joined together to insure and protect their businesses and families. They were guided by powerful ideals that we’ve continued to stand behind and evolved throughout the years: we do the right thing, we believe people count, we courageously shape the future together, and we go above and beyond for the people we serve. Guardian employees embrace and live by these values every day. They remind us to put people at the heart of all we do so that we can help protect what matters most to you. Want to help bring these values to life? Join us for a rewarding career and the opportunity to shape the future. Disclosures: Financial information concerning Guardian as of December 31, 2022, on a statutory basis: Admitted assets = $76.0 billion; liabilities = $67.2 billion (including $55.0 billion of reserves); and surplus = $8.8 billion. Dividends are not guaranteed. They are declared annually by Guardian’s Board of Directors. Guardian® is a registered trademark of The Guardian Life Insurance Company of America. © Copyright 2023 The Guardian Life Insurance Company of America 2023-156184 Exp. 5/25

Company type: XLarge

Industry: Financial Services

Founded: 2018

Company size: 5001 - 10000

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Job description

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.

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. Explore our company benefits at www.guardianlife.com/careers/corporate/benefits. 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 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.

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.

Notice Regarding Guardian’s Use of Artificial Intelligence in Recruitment

As part of Guardian’s job application process, Guardian may use artificial intelligence tools (“AI Tools") to automate the sorting and filtering of information provided by applicants as part of its preliminary screening. This preliminary screening may be used to help identify applicant materials and resumes relative to their indication that the applicant meets the requirements for the specific job for which they are applying, as specified in the listing posted on Guardian’s jobs website (Careers at Guardian at https://www.guardianlife.com/careers). At Guardian, we do not use AI Tools to substantially assist or replace human judgment or discretionary decision making in our hiring process. All hiring decisions will be made by Guardian colleagues.

Please be aware that if you apply for a specific position with Guardian, you will have the choice of opting out of Guardian’s use of AI Tools during the job application process. If you would like to request an alternative process that does not utilize AI Tools or would like to request a reasonable accommodation, within ten business days of your position application, you must email your request to MyHR@glic.com, making sure to provide your name and job requisition identification number. Guardian will retain your applicant materials and resume and all information therefrom in accordance with Guardian’s document retention policy, a copy of which you may request via MyHR@glic.com.

Additionally, at applicable times, Guardian will make public the most recent bias audit results for such AI tools, which may be found here.

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

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