Senior RN Clinical Consultant, Disability AppealsJoin to apply for the Senior RN Clinical Consultant, Disability Appeals role at Guardian LifeSenior RN Clinical Consultant, Disability Appeals1 week ago Be among the first 25 applicantsJoin to apply for the Senior RN Clinical Consultant, Disability Appeals role at Guardian LifeGet AI-powered advice on this job and more exclusive features.The Senior RN Clinical Consultant will work in partnership with Clinical and Vocational Leaders to provide ongoing coaching and oversight to Clinical Consultants and will serve as clinical subject matter expert in all lines of business (STD/LTD/Appeals) and products, action planning management, and Guardian systems. This incumbent will have a strong clinical and client focus to assist in ensuring the fair and accurate assessments of medically supported functional abilities. They will assist in cultivating talent and foster an environment of continuous learning. They will promote organizational excellence by demonstrating leadership, problem-solving behaviors, and viewing challenges as opportunities. This individual will work with the Clinical Team Manager to drive performance and ensure the team meets their goals. They will effectively communicate & explain departmental initiatives and changes as they relate to organizational goals & strategies. They will assist the Clinical Team Manager in managing and resolving issues that come up related to clinical processes, claim management activities, customer inquiries, and quality.You areA highly motivated and reliable individual who can work with varying levels of supervision – independently or collaboratively. You are diligent and a decisive decision maker who can prioritize multiple tasks simultaneously with a positive attitude.You haveA minimum of 3+ years of (STD, LTD, Appeals) claim experience, minimum of 2 years disability experienceA minimum of 5 years in direct patient care settingsRN REQUIRED, BSN and CCM preferredDemonstrated proficiency in verbal and written communication, as well as strong presentation abilitiesAbility to exercise independent & sound judgment in decision makingStrong problem-solving, analytical, clinical, and information research skillsExcellent time management & organizational skillsDemonstrated ability to multi-task with the ability to manage continually changing priorities and the ability to prioritize work based on customer service needs and departmental regulationsThe ability to remain flexible due to changing business needsProven track record to mentor and coachProficiency in MS Word, Excel, PowerPoint, DCMS, Claim Facts, and iProcessYou willTrain and mentor, all new Clinical ConsultantsProvide ongoing training, coaching and development to all Clinical Consultant membersOrganize and present at least one Clinical Training session for the Claims teams over the course of a yearWork with Team Manager to delegate, distribute, and monitor workloads within the department to meet departmental regulations, improve efficiency and reduce or eliminate backlogsAssist Team Manager when needed to monitor caseloads, productivity, and participate in calibration sessions with our Clinical CMA and provide feedback to leadership and team membersOversee external vendor utilization within teamLeverage knowledge and skills to flex and assist the overall team meet its goals, (i.e., assist with STD/LTD/ Appeals, flex and assist if needed)Collaborate with claims partners to resolve conflicts and establish procedures that promote clinical claim management accuracy and improved customer serviceAddress escalated customer inquiries and formal complaints. Senior BHCM will also be first point of contact for SI or mental health crisis callsSupport training initiatives by identifying knowledge gaps and providing ideas for improvementSupport Clinicians in developing efficient desk & time management skillsCollaborate with peers and leadership to ensure consistency with mentoring and coachingCo-facilitate team meetings to share best practices, workflow changes, trends, and insights in alignment with Group benefits strategiesProvide desk coverage for leadership as neededLocationThis is a remote position with occasional travel as needed for department meetings determined by the people leader.Salary Range:$67,450.00 - $110,815.00The 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 PromiseAt 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-BeingAs 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 for most Company benefits.Equal Employment OpportunityGuardian is an equal opportunity employer. All qualified applicants will be considered for employment without regard to age, race, color, creed, religion, sex, affectional or sexual orientation, national origin, ancestry, marital status, disability, military or veteran status, or any other classification protected by applicable law.AccommodationsGuardian is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. Guardian also provides reasonable accommodations to qualified job applicants (and employees) to accommodate the individual's known limitations related to pregnancy, childbirth, or related medical conditions, unless doing so would create an undue hardship. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact applicant_accommodation@glic.com.Current Guardian Colleagues: Please apply through the internal Jobs Hub in Workday.Seniority levelSeniority levelMid-Senior levelEmployment typeEmployment typeFull-timeJob functionJob functionHealth Care ProviderReferrals increase your chances of interviewing at Guardian Life by 2xGet notified about new Senior Nurse jobs in Bethlehem, PA.We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
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