Nurse Consultant
MetLife - Oriskany, NY

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Job Location

Oriskany, NY

Virtual Location
No

Job Description

The expected outcome of this position is to deliver timely clinical services while meeting case management standards and principles and applicable performance guarantees.

The focus includes enhancement of the quality of claim decisions and facilitation of safe, timely and appropriate return-to-work (RTW) outcomes through the contribution of clinical expertise.
The individuals in this role will be knowledgeable regarding the customer’s business, disability plan design, RTW philosophy and processes. Through effective working partnerships with the Customer, they will identify RTW potential and will coordinate activities to achieve return to work outcomes that are successful for the Customer and employee.

Functional Responsibilities:
Manages assigned caseload of complex cases; applies specialized training/knowledge to the assessment of cases; provides technical insight and advice.

Reviews, records, and analyzes medical records and treatment plans data to make claims settlement determination

Compares duration control guidelines and clarifies functional inconsistencies

Provides recommendations to team regarding employee's current or potential functional abilities

Develops goal-focused return-to-work plans

Addresses barriers for return to work

Facilitates communication between employee, physician and employer and partners with all parties to achieve a positive outcome

Follows established claim policies and practices to resolve claims and issues

Performs other related duties as assigned or required

Occasional travel to customer sites or business meetings which may require 1-2 overnight stays

Supervisory Responsibilities:
None. May provide guidance to junior staff members.

Job Requirements

Current state RN licensure

3-5 years of insurance claims experience

3-5 years of adult clinical nursing experience in a hospital setting

Preferred Qualifications:
Prefer additional experience in Disability/Worker’s Comp, Occupational Health or Rehab Nursing.

Bachelor’s Degree in Nursing

Strong computer skills in Word, Excel, Power Point and ability to quickly navigate the internet, Lotus or Outlook, etc.

Strong verbal and written communication skills

Strong interpersonal and influence skills

Excellent analytical and problem solving skills

Ability to work independently with minimal supervision

Strong customer service skills

Excellent negotiating skills

Proven presentation skills

Ability to reason through, interpret, and apply standardized procedures

Ability to prioritize, effectively manage multiple tasks, and work in a fast paced environment and meet multiple deadlines while maintaining complete and accurate information, which will be updated as changes occur

Ability to be flexible in a changing environment

Desire to take responsibility for own career development

Experience Required
Three to Five Years

Education Required
Bachelors Degree Preferred

Business Category

Americas Region

Job Category
Claims

Salary Grade

29

Number of Openings

1

Equal Employment Opportunity
MetLife is proud to be an equal opportunity/affirmative action employer. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce.

How To Apply
For immediate consideration, click on the Apply Now button below. You will be directed to complete an on-line profile which may take 15 – 20 minutes to complete. Upon completion, you will receive an automated confirmation email verifying you have successfully applied to the job.

MetLife - 15 months ago - save job - block
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