Clinical Support Consultant - RN

MetLife • Aurora, IL • 1w 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

Go to Apply

Share this job

Similar Jobs

Registered Nurse (Overnights)

Monte Nido • Naperville, IL • 15h ago

Hospital & Medical

We save lives while providing the opportunity for people to realize their healthy selves. Registered Nurse (Overnights) Clementine Naperville Naperville, IL Clementine Naperville, is a residential treatment program exclu...

15h ago

Go to Apply

Medical Interpreter- Registry

Rush Copley Medical Center • Aurora, IL • 15h ago

Hospital & Medical

Interprets for the medical center, and acts as a resource for patients and the community for Hispanic advocacy. Must be a high school graduate with excellent verbal and written skills in both English and Spanish. Must po...

15h ago

Go to Apply

Registered Nurse - PRN

Wellpath • Saint Charles, IL • 15h ago

Hospital & Medical

You Matter Make a difference every day in the lives of the underserved Join a mission driven organization with a people first culture Excellent career growth opportunities Join us and find a career that supports: Caring...

15h ago

Go to Apply

Physical Therapist (School) - ST

Amergis • Yorkville, IL • 20h ago

Hospital & Medical

Salary: $330 / Week Role: Physical Therapist (part time)-Yorkville, IL Grade Level K-22 years old Caseload Details: Needing approx. 20-30 hours for the summer 5-6 hours a week, Can be flexible Start/End Date: Extended sc...

20h ago

Go to Apply

Pharmacy Operations Manager

Walgreens • Plainfield, IL • 22h ago

Hospital & Medical

Job Description: Where state and federal laws/regulations allow, accountable for performing day-to-day non-clinical pharmacy operations, administrative activities; Ensures efficient pharmacy workflow and a positive patie...

22h ago

Go to Apply

Registered Nurse - NICU

Rush Copley Medical Center • Aurora, IL • 1d ago

Hospital & Medical

Position Summary: The registered nurse is responsible for the assessment, planning, implementation, and evaluation of the patients' status, plan of care, and goal achievement. Care is provided in a compassionate, profess...

1d ago

Go to Apply

Clinical Account Manager

Alteas Health • Naperville, IL • 1d ago

Hospital & Medical

This job was posted by https://illinoisjoblink.illinois.gov : For more information, please see: https://illinoisjoblink.illinois.gov/jobs/12751217 Alteas Health is a rapidly growing, innovative dynamic company looking fo...

1d ago

Go to Apply

Nurse Case Manager

The Hartford • Naperville, IL • 3d ago

Hospital & Medical

Medical Case Manager - CT08GE We're determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals...

3d ago

Go to Apply

Medical Assistant

Actalent • Bolingbrook, IL • 4d ago

Hospital & Medical

Job Title: Medical Assistant Job Description Join a small dermatology clinic in Bollingbrook, where you will be part of a close-knit team dedicated to providing excellent patient care. With a focus on general dermatology...

4d ago

Go to Apply

Certified Medical Assistant MA

AdventHealth • Bolingbrook, IL • 4d ago

Hospital & Medical

Certified Medical Assistant MA - UChicago Medicine AdventHealth Great Lakes Urology All the benefits and perks you need for you and your family: Up to $1,500 Sign-on Bonus Benefits from Day One Paid Days Off from Day One...

4d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.