Nurse Clinical Consultant
Unum US - Portland, ME
Unum is a company of people serving people. As one of the world's leading employee benefits providers and a Fortune 250 company, Unum helps protect more than 25 million working people and their families in the event of illness or injury.

Headquartered in Chattanooga Tennessee, Unum has significant U.S. operations in Portland, Maine, Worcester, Massachusetts and Glendale, California with 35 field offices nationwide.

Principal Duties and Responsibilities

Assess medical information from the perspective of adequacy and consistency

Clarifies medical information and/or interprets medical reports (IMEs, hospital and office records, and doctor's calls and letters) and evaluating Restrictions & Limitations (R&Ls) to assess current and ongoing level of impairment. Makes contacts to insured, employer, and the healthcare provider(s) as indicated.
Synthesizes pertinent facts and answers questions in collaboration with claims professionals.
Meets standards set by management for quality and volume of work performed.

Apply current clinical knowledge to medical data regarding diagnosis, treatment, prognosis and impairment

Participates proactively as medical navigator through early assessment of medical issues, work capacity, and Return-To-Work (RTW) opportunities.
Determines what medical information is needed to evaluate claim on ongoing basis. Conducts analysis of medical information, including current treatment plan.
Synthesizes pertinent facts and answers questions in collaboration with On-Site Physician (OSP) claims professionals.
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 OSP, claims professional, legal counsel, or vocational resource.

Provide input and assistance to identify and collect pertinent medical information through outreachcommunications with attending physicians, claimants/insureds, and employers.

Demonstrates excellent verbal and written communication to gather and report information, clarify restrictions and limitations, and assist with return to work.
Effectively and accurately educates attending physicians and other treating sources about the need for R&L's, medical records, and the participation of the claimant.
Operates with urgency to support assigned Disability Benefit Specialist (DBS) in effective and appropriate claim direction to identify and facilitate next steps and follow up needs on each individual claim file.
Makes AP contacts as indicated and is able to discuss complex medical issues and document outcomes of discussion

Coordinates with Voc Rehab Consultants (VRC) and others in regard to return to work services

Evaluates each claim file for RTW opportunities and partners with VRC to develop RTW plan as indicated.

Provides consultation and education to peers and a variety of other constituents

Demonstrates knowledge, skill, and problem solving in communicating effectively with both internal customers and with external resources.
Works collaboratively with OSP/ Lead MD/ Clin Voc Director, 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.

Professional Development

Sets goals with management for personal and professional growth and reassesses throughout the year.
Achieves and maintains professional certifications by attending educational seminars and other required educational activities (i.e. ethics, confidentiality)
In alignment with developmental goals and business needs participates in projects and committees.

Performs other duties as assigned.

Licensed Registered Nurse with Bachelor of Science degree strongly preferred
Relevant experience, including direct clinical work with adult clients for 5 years
Professional certification and insurance training preferred.
Will consider Associate Degree with additional credentials such as CCM or CDMS and work experience in related fields
Demonstrated analytical and critical thinking skills.
Excellent verbal and written communications skills.
Excellent interpersonal/negotiation skills.
Strong team and collaborative skills. Ability to work in a fast paced, team based, corporate environment
Ability to mentor others and to give and receive constructive, behaviorally based feedback with peers and partners.
Meets the standards for this position as defined in the Talent Management framework.
Unum offers world-class training and development, generous compensation and benefits packages, and a culture built on employee ideas.

Unum provides equal employment and advancement opportunities for all employees regardless of a person's race, color, religion, national origin, age, disability, military status, gender, sexual orientation, gender identity or expression.

Unum - 14 months ago - save job - block