Senior Clinical Consultant

You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.

Job Description:

Location: We support US flexible working arrangements in the contiguous 48 states.  

At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, you’ll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America. 

The opportunity: 

The Senior Clinical Consultant is responsible for the enhancement of FullscopeRMS claims management by serving as a medical consultative resource. Responsibilities include the review of clinical records and communications with providers and other parties to facilitate the clinical aspects of claim management and benefits determination process.

How you will contribute: 

• Performs a critical review and analysis of medical information

• Completes written and verbal consultations with all levels of the claims staff that will clearly outline the answers on functional parameters as well as the length and severity of the medical condition(s)

• Holds “walk in” consultation meetings with claims 

• Ensures quality investigations of medical information utilizing the resources available

• Reviews and evaluates Independent Medical Examination (IME) reports and Functional Capacity Evaluation (FCE) reports 

• Helps claims staff increase knowledge of medical terminology and conditions through training and feedback

• Assists with the development of return-to-work plans 

• Maintains knowledge and skills regarding medical advances and communicates/educates claims staff in one-on-one meetings 

• Continues to research rare/unusual medical conditions and be knowledgeable on the tools necessary to perform this research

• Communicates verbally and in writing with providers, subscribers, and other appropriate contacts in a professional and effective manner, resolving discrepancies and clarifying medical information, including diagnosis, treatment, prognosis, restrictions, limitations, and duration of conditions 

• Participates in triage and multi-disciplinary roundtable sessions to provide expertise on medical issues 

• Maintains RN license 

• Conducts in-service training for claims staff on various medical conditions and treatment 

• Participates in industry meetings 

What you will bring with you: 

• Strong knowledge of medical treatment protocols 

• Experience in utilization review/health care industry insurance preferred 

• Strong research, analytical, critical thinking, problem solving and decision-making skills 

• Ability and desire to work in a fast-paced, service-oriented environment 

• Excellent verbal communication skills, with the ability to be both pleasant and professional 

• Strong written communication skills 

• Ability to work well on one’s own and in a team environment 

• Strong interpersonal and customer service skills 

• Current and valid Registered Nurse license  

• AA or Nursing Diploma required; BSN, BA or BS preferred 

• Minimum 3 years of clinical experience required 

• Strong computer skills, proficient in PC environment and MS Word, Excel, and email systems

• Ability to initiate and prioritize regular work duties and projects 

• Detail oriented, organized, the ability to multi-task, and strong time management skills 

Do you see yourself in this role even if you haven’t checked all the boxes above? We welcome all talented candidates and are committed to a culture that represents diversity in all forms. If you think you might thrive in this setting, we would love to hear from you. 

Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you! 

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