Clinical Consultant

Clinical Consultant

Requirements

• RN licensure, active and unrestricted, BSN preferred
• Minimum of 3 years clinical experience working with an adult working age population
• Ability to communicate effectively and professionally with a wide variety of both internal and external Sun Life business partners, peers, and resources
• Attention to detail with documentation, reporting and communication
• Self-directed with an ability to work independently and make independent judgments and decisions
• Strong organizational skills, including the ability to prioritize work and multi-task
• Strong research, analytical, critical thinking, problem solving skills and decision-making skills
• Ability to thrive in a fast-paced, service-oriented environment
• Strong computer skills, proficient in PC environment and MS Word, Excel, and email systems
• A drive to continuously learn, build, and grow professionally

Responsibilities

• 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 in regard to 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

Preferred Qualifications

• BSN preferred
• Specialty certification such as CCM, CRRN, or eligible with desire to pursue a plus
• Experience in a rehabilitation setting, Occupational Health, Case/Care Management, Disability Insurance, Group Benefits, or Workers compensation a plus