RN Clinical Consultant, Disability Claims

The RN Clinical Consultant, Disability Claims 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. You will be responsible for restrictions, limitations and duration impacting functional capacity based on medical data, to assist the Claim Managers in determining claim liability. In addition, you will collaborate 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 will also review long and short-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.

You are

• Well versed with a strong clinical background in understanding and applying rationale of how injury or illness may impact the claimant’s function.

• Excellent with verbal and written communications and able 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.

• Able to work collaboratively with internal vocational rehab specialists in identifying opportunities for return to work.

• Experienced in identifying and resolving customer issues, when possible, to enhance the customer experience.

You will

• 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.

• 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. 

You have

• A valid RN license from an accredited school of nursing.

• Proficiency in multiple computer systems required.

• CCM preferred.

• 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/Travel

• This role is remote with occasional in office meetings as required by the people leaders. No travel required.

Salary Range:

$67,450.00 - $110,815.00

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