Clinical Support Consultant - RN

MetLife • Oriskany, NY • 2w ago

Location: Must live within a commutable distance of the Oriskany, NY, Tampa, FL, Bloomfield, CT Cary, NC, Aurora, IL, Bridgewater, NJ, Omaha, NE, Warwick, RI, Clark Summit, PA, San Juan, PR office

Once a month in office for meetings

Key Responsibilities:

Independently assess, analyze and render appropriate claim decisions pursuant to certificates on all claims.

Compare duration control guidelines and clarifies functional inconsistencies.

Develop goal-focused return-to-work plans and or barriers for return-to-work. Partner with Return -to-Work Coordinator on account to ensure successful RTW.

Clarify functional capacity through independent problem solving measures and discretion (gathering medical, vocational, and other information, efficient use of resources, and action planning) sufficient to determine initial and ongoing liability by adhering to federal and state law to maintain appropriate and timely claim outcomes.

Communicate clearly and concisely to influence return to work, discuss terms of the certificate, and the basis for payment/non-payment.

Communicate with a variety of constituents (for example, claimants, doctors, nurses, employers, and attorneys) to gather information relevant to assessing, analyzing and rendering decisions based on the provisions of the policy and their own discretion, with limited guidance by supervisory personnel.

Prepare written summary for Quarterly customer meetings to review cases that are identified via report parameters, you or the customer to discuss and participate in quarterly meetings with the Vocational resource and Account team member.

Participate in claim review meetings as requested by the customer.

Utilize tools independently and accurately to identify work to be completed across the entire claim block, prioritize work, determine if/when to involve specialty resources such as Psychiatric Clinical Specialist, Medical Director or other clinical staff to obtain additional information on a claim by articulating and documenting their rationale for claim direction, possessing the autonomy to take steps outside of CMG guidelines to the extent supported by documented rationale and the facts of the claim file.

As the sole owner of the claim, determine return to work potential and strategy, identify a likely claim progression based on the facts of the claim and take action on their own assessment of the claim and provide mentoring and/or coaching to less experienced team members. Performs other duties as assigned or required.

Manages assigned caseload of short-term disability (STD) and/or Family & Medical Leave Act (FMLA) claims; applies specialized clinical training/knowledge to the assessment of cases.

Essential Business Experience and Technical Skills:

Required:

2+ years of Clinical Experienced required

Nursing Degree with RN license required

Strong communication skills, both written and oral.

Demonstrated critical thinking in activities requiring analysis, investigation, and/or planning.

Strong customer satisfaction focus.

Preferred:

BSN Preferred

Disability Claims Experience

Travel

Less than 10% (travel to customer sites for business meetings 1 x per year)

Equal Employment Opportunity/Disability/Veterans

If you need an accommodation due to a disability, please email us at accommodations@metlife.com. This information will be held in confidence and used only to determine an appropriate accommodation for the application process.

MetLife maintains a drug-free workplace.

MetLife

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