Senior Clinical Consultant (Remote)

The Senior Clinical Consultant will work in partnership with Clinical and Vocational Leaders to provide ongoing coaching and oversight to Clinical Consultants and will serve as clinical subject matter expert in all lines of business (STD/LTD/Appeals) and products, action planning management, and Guardian systems.  This incumbent will have a strong clinical and client focus to assist in ensuring the fair and accurate assessments of medically supported functional abilities. They will assist in cultivating talent and foster an environment of continuous learning.  They will promote organizational excellence by demonstrating leadership, problem-solving behaviors, and viewing challenges as opportunities.  This individual will work with the Clinical Team Manager to drive performance and ensure the team meets their goals.  They will effectively communicate & explain departmental initiatives and changes as they relate to organizational goals & strategies.   They will assist the Clinical Team Manager in managing and resolving issues that come up related to clinical processes, claim management activities, customer inquiries, and quality. 

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 with a positive attitude.  

You have:  

• A minimum of 5 years of (STD, LTD, Appeals) claim experience, minimum of 2 years disability experience 

• 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 

• Proven ability to mentor and coach 

• Proficiency in MS Word, Excel, PowerPoint, DCMS, Claim Facts, and iProcess 

You will: 

• 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  

• When not engaged in the above activities are expected to meet the same metrics and performance objectives as a Clinical Consultant 

Reporting Relationships  

As our Senior Clinical Consultant, you will report to a Clinical and Vocational Team Manager, who reports to the Head of Disability Clinical and Vocational Organization   

Location 

• Flexible – work primarily from home. May be expected to come into a Guardian work location occasionally, as determined by their people leader.  

Travel 

• Occasional 0-10% of the time.