Clinical Nurse Consultant / Sr. Clinical Nurse Consultant (Group Claims) - Omaha, NE or Chattanooga, TN
Job no: 496593
Work type: Full Time Regular
Location: Nebraska, Tennessee
Categories: Claims/Claims Processing
|Responsible for reviewing, analyzing, and interpreting medical information associated to group disability claims. The position will complete a thorough evaluation of all medical information available to determine restrictions, limitations, and provide consulting on return to work and recovery opportunities. Facilitates educational opportunities for the disability claims staff and provides clinical subject matter expertise for business partners.
Essential Job Functions:
- Provides consultative services including analyzing and interpreting medical information on long term disability and short term disability claims. Demonstrates the ability to assess medical information for adequacy and consistency which is necessary in order for the nurse to offer an appropriate medical opinion. Obtains and clarifies medical information and interprets medical reports. Arranges relevant material into facts, considers the uniqueness of each claim in order to document medical opinions. Identifies medical restrictions, limitations, provides expected duration for recovery and recommendations for next steps.
- Provides clarification for independent medical exam (IME), medical records, lab results, office notes, MRIs, etc. and any other medical information that may have been submitted on behalf of the claim.
- Reports and documents information.
- Remains aware of the impact that adherence to compliance, sense of urgency and quality have on our customers.
- Makes recommendations on the appropriateness of coordinating external medical consultations when applicable. Keeps management informed of the quality of services and resources while maintaining risk strategies that are cost effective.
- Establishes effective communications with medical facilities and providers. Effectively educates attending physicians and other resources about restrictions, limitations, work capacity and initiates discussions regarding complex medical conditions and seeks clarification from attending physician when necessary.
- Works directly with the Vocational Rehabilitation Specialists in identifying early intervention opportunities through disability file reviews.
- Assists the law division by participating in depositions or claim trials.
- Utilizes clinical background and experience to determine appropriate medical handling techniques that focus on disability case management, durational guidelines, early intervention and return to work strategies.
- Develops and conducts training programs and presentations to educate the claim associates on medical or disability topics.
- This position requires up to 33% travel, which may include flying and/or driving and some overnight stays.
- This position requires sitting over 66% of the time.
- This position requires Visual Acuity at 20 inches (or less) over 66% of the time.
- Achieves and maintains professional license and certifications by attending educational seminars and other required educational activities.
- Registered nurse with knowledge or experience in disability evaluation, early intervention concepts, and claim procedures.
- Sound judgement, high level of initiative and creativity, proven analytical and problem solving skills, strong decision making ability and confidence to make difficult decisions.
- Excellent interpersonal skills, highly collaborative, teaching ability and strong organizational skills.
- Ability to type and maneuver through multiple office and business systems.
- Ability to work autonomously, apply critical thinking, meet deadlines and demonstrate proficient written and verbal communication skills.
- Working knowledge of disability policy language and provisions as well as regulatory environment, i.e., ERISA.
- Ability to work well under pressure and demonstrate a high level of flexibility to meet the needs of a rapidly changing environment.
- Associate Degree in Nursing, a minimum of 5-7 years of relevant direct patient care are required. Bachelor of Science degree is preferred.
- Bachelor's Science Nursing (BSN) is preferred
For inquiries about the position or application process, contact our HR Helpline at 1-800-365-1405.
If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact a Human Resources Representative at 1-800-780-0304. We are available Monday through Friday 7 am to 4:30 pm CST.
Mutual of Omaha and its affiliates are an Equal Opportunity /Affirmative Action Employer, Minorities/Female/Disabled/Veteran
To All Recruitment Agencies: We do not accept unsolicited agency resumes and we are not responsible for any fees related to unsolicited resumes.
Advertised: Central Daylight Time
Applications close: Central Daylight Time
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