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: 

Sun Life operates with a Work Is Healthy (WisH) approach for disability claims management. As a Clinical Consultant within our Clinical Services team, you will apply your clinical expertise as a member of an interdisciplinary team that focuses on returning clients to optimal levels of productivity.  This role does not involve hands-on assessment or direct care. All work is solely performed using electronic medical records and phone/fax communication.  

How you will contribute: 

Conduct comprehensive clinical assessments of disability claims that are referred in different venues. 

·         Clarifies medical information and/or interprets medical reports (IMEs/FCEs, hospital and office records, and health care provider’s (HCP) calls and letters) and evaluates restrictions and limitations to assess current and ongoing level of impairment.   

·         Synthesizes pertinent facts and answers questions in collaboration with claims professionals. 

·         Meets standards set by management for quality and performance. 

Applies current clinical knowledge to medical data regarding diagnosis, treatment, prognosis, and impairment.  

·         Participates proactively through early assessment of medical conditions, functional capacity, and return to work (RTW) opportunities. 

Provides whole person analysis, documenting rationale for opinions and recommended next steps. 

·         Makes appropriate decisions and takes action as indicated to obtain additional medical information and/or referral to the appropriate resource, such as physician, claims professional, or vocational resource. 

Provides input and assistance to identify and collect pertinent medical information through outreach communications with attending physicians, claimants/insureds, and employers.  

·         Demonstrates excellent verbal and written communication to gather and report information. 

·         Effectively and accurately educates attending physicians and other health care providers about Sun Life’s WisH program. 

·         Operates with urgency to support claims professionals to determine claim direction and facilitate next steps.  

·         Outreach to health care provider (HCP), insured, or as indicated to discuss complex medical issues and document outcomes of discussion. 

Coordinates with Vocational Rehabilitation Consultant (VRCs) and others regarding return to work services.  

·         Evaluates each claim file for RTW opportunities and partners with the VRC to develop RTW plans as indicated. 

·         Evaluates claims for potential accommodations or partial RTW.  

·         Partner with VRC to identify functional capabilities for alternative occupations/job duties. 

Provides consultation and education to peers and a variety of other business partners. 

·         Demonstrates knowledge, skill, and problem solving in communicating effectively with both internal customers and with external resources. 

·         Works collaboratively with clinical and claims professionals to improve disability claim management practices. 

·         Provides clinical input in claims meetings and leads discussions to facilitate appropriate clinical intervention.

·         Provides training and mentoring to new clinical, vocational, claims, and other staff as appropriate.  May provide training to groups of peers and/or claims professionals to update their knowledge/skills. 

What you will bring with you: 

·         Ability to work with a diverse group of people.

·         RN licensure, active and unrestricted, BSN preferred.

·         Specialty certification such as CCM, CRRN, or eligible with desire to pursue.

·         3+ years of cli