Nurse Consultant Bilingual\Spanish
MetLife - Tampa, FL

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Job Location
Tampa, FL

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

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 clinical nursing experience in a hospital environment.

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


  • 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


  • Bilingual English/Spanish

Education Required
Bachelors Degree Preferred

Business Category
Americas Region

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.

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