Job description
The Clinical Case Manager serves as a clinical resource for the investigation and assessment of medical information regarding disability by providing comprehensive medical reviews and analysis of long-term disability claims. The Clinical Case Manager identifies restrictions, limitations and duration impacting functional capacity based on medical data, to assist the Claim Managers in determining claim liability. The Clinical Case Manager collaborates with treating providers to assist individuals to obtain appropriate care and ensure optimal treatment outcomes and acts with urgency and ownership to resolve customer issues and prioritize the customer experience.
You are
An experienced RN Clinical Case Manager possessing a strong clinical background to understand and apply rationale of how injury or illness may impact the claimant’s function; possess excellent verbal and written communication skills to gather and report information accurately, ask appropriate questions to facilitate partnership with treating providers, claimants, and internal partners to encourage participation of claimant in appropriate treatment goals. You work collaboratively with internal vocational rehab specialists in identifying opportunities for return to work and proactively identify and resolve customer issues, when possible, to enhance the customer experience.
You will
- Review long-term disability claims to resolve impact of claimants’ medical condition on their function as well as the impact of their medical treatment in achieving improved functional outcomes.
- Review and assess claimant subjective reports and objective medical evidence to resolve impact of medical conditions on function.
- Clarify medical information, interpret medical reports, and evaluate restrictions and limitations to assess current and ongoing level of impairment.
- Apply current medical knowledge regarding diagnosis, treatment, prognosis, and impairment.
- Participate proactively through early assessment of medical issues, work capacity and RTW opportunities.
- Conduct analysis of claimant’s current treatment plan and collaborate with health care providers and claimants to promote accountability for the appropriateness and status of treatment plan and length of disability.
- Plan for ongoing case management through proactive partnering with treating providers to move claimants toward appropriate care.
- Proactively contact claimants to obtain information about their condition and impact on work and daily living as part of ongoing assessment of medical condition.
- Contact treating providers to discuss treatment plans and clarify treatment and RTW goals. Educate providers and claimants on the positive impact of return to work to ensure improved functional status and medical outcomes.
- Serve as a technical resource on the medical aspect of the claim.
- Seek opportunities to educate claim staff and peers on medical aspect of disability. Provide ongoing training and mentoring to claims staff and peers regarding issues impacted by the nature of injury or illness and its impact on function in work or daily activities.
- Provide consultation with peers.
- Work collaboratively with vocational rehab specialists to find opportunities for return-to-work services.
- Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals.
- Utilization of independent vendors to perform independent medical assessments.
- Define issues to be addressed or clarified by outside physician or provider and be responsible for quality of review.
- Follow standard processes for developing reviews and sharing feedback with treating providers.
- Demonstrate diplomacy and professional proficiency through interactions with medical providers, claim staff, and peers and display empathy and a focus on customer service in all interactions.
- Manage case load efficiently, prioritize priorities, provide timely intervention, and implement continuous quality operational improvement.
You have
- RN from an accredited school of Nursing with a valid nursing license in good standing.
- Minimum of 5 years of clinical nursing experience, with at least 2 of those years within an acute care setting.
- Disability experience strongly preferred.
- CCM preferred.
- Proficiency in computer systems required.
- Excellent written and verbal communication skills.
- Ability to exercise independent and sound judgment in decision-making.
- Excellent organizational and time management skills.
- Ability to multi-task while managing work and continually changing priorities.
- Display self-motivation and be able to work independently.
- Experience working collaboratively with multiple professional fields and diverse populations.
- Strong attention to detail.
- Experience researching information and investigative skills.
Location
This is a remote position with preference given to candidates in proximity to a regional office where you would come into an office two days per week with a flexible schedule.
Our Promise
At 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.
Salary Range
$55,100.00 - $102,340.00
The 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.
Inspire Well-Being
As 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.
Health Care
-
Choice of [high deductible/copay] medical plans* with prescription drugs, including coverage for fertility and transgender inclusive benefits
-
Dental plan
-
Vision plan
-
Health care accounts – flexible spending, health reimbursement, and health savings accounts
-
Critical illness insurance
Life and Disability Insurance
-
Company-paid Life and Disability insurance plus voluntary supplemental coverage
-
Accident insurance
Retirement and Financial
-
401(k) retirement plan with a company match, plus an annual age/service-based Company contribution and an annual profit-sharing contribution, if applicable
-
Complimentary 1:1 financial guidance with a licensed Fidelity representative
Time Off and Remote Work
-
Flexible work arrangements (part in-person/part remote)
-
Unlimited paid time off for most roles plus time off for volunteering, jury duty, voting, and bereavement
-
Personal holidays for colleagues to use in recognition of religious, cultural, or civic days
-
Paid parental leave and paid family and medical leave policies
Emotional Well-being and Work-Life
-
Emotional well-being, mental health, and work/life resources powered by Spring Health
-
Wellness programs, including fitness program and equipment reimbursement
-
Child, adult, and elder back-up care support through Bright Horizons
-
Adoption assistance
-
College planning
-
Tuition reimbursement
-
Student loan assistance
-
Commuter benefits in select metropolitan areas
Justice, Equity, Diversity & Inclusion (J.E.D.I.)
-
Employee Resource Groups that advocate for inclusion and diversity
-
J.E.D.I. certification and training programs
-
Matching gifts/volunteering
Benefits apply to full-time eligible employees. Interns are not eligible for most Company benefits.
Equal Employment Opportunity
Guardian 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.
Guardian is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. 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
.
jjbodyshop.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, jjbodyshop.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, jjbodyshop.com is the ideal place to find your next job.