Clinical Consultant - Benefit Operations

General Summary

The clinical consultant is responsible for reviewing, analyzing and interpreting medical information. Works collaboratively with claims professionals, on-site physicians and other resources in multiple settings to assess medical information and determine appropriate next action steps. Collaborates with healthcare providers to clarify functional capacity, recovery expectations, treatment plans and initiate return to work plans where appropriate. Delivers exceptional service in every interaction, taking full accountability for a positive experience.

Principal Duties and Responsibilities

• Application of medical knowledge through assessment and synthesis of claim file information and ability to offer balanced conclusions
• Ability to concisely communicate (written and verbally) complex medical issues in a fast-paced, multidisciplinary team work environment
• Collaboration with internal resources to determine which pertinent medical documentation is needed to accurately assess file direction
• Collaboration with external resources to establish partnerships, discuss treatment plans, and clarify functional capacity and assess file direction
• Provides coaching of non-medical staff to increase medical knowledge
• Operates with a sense of urgency and flexibility to meet the needs of a rapidly changing environment, while meeting performance standards set for quality and quantity of work
• Displays capacity and thirst for learning and developing broad business and leadership skills; openness to diverse ideas & experiences and has self-awareness re: strengths and areas of development.
• Required to maintain professional certifications, stays abreast of new trends in the medical field and completes other required educational activities

Job Specifications

• Associate Degree in Nursing and active RN License is required but BS degree strongly preferred
• 3+ years clinical experience preferred
• Proven ability to work in a fast-paced, team environment