RN Clinical Consultant

Are you a registered nurse who is passionate about helping individuals achieve optimal recovery and return-to-work outcomes? Guardian is seeking an RN Clinical Consultant to serve as a clinical expert supporting the evaluation of short-term and long-term disability claims. In this role, you will analyze medical information, assess functional capacity, collaborate with healthcare providers, and provide clinical guidance that supports claim decisions.

You will play a critical role in enhancing customer outcomes through sound clinical judgment, proactive case collaboration, and a commitment to exceptional service.

A highly motivated and clinically skilled registered nurse who thrives in a fast-paced, customer-focused environment. You can work independently while also collaborating effectively with claim professionals, healthcare providers, vocational specialists, and internal business partners. You are analytical, detail-oriented, and decisive, with the ability to evaluate complex medical information and translate clinical findings into actionable recommendations. You act with urgency and accountability while maintaining a strong commitment to improving claimant outcomes and customer experiences.

• Active Registered Nurse (RN) license
• Minimum of 5 years of direct acute patient care experience
• Minimum of 3 years’ experience as a clinical consultant in LTD and/or STD (LTD preferred)
• Strong knowledge of medical conditions, treatments, and their impact on functional capacity and disability duration
• Excellent verbal and written communication skills
• Strong clinical assessment, analytical, critical thinking, and research skills
• Ability to exercise independent judgment and make sound clinical decisions
• Strong organizational and time-management skills with the ability to prioritize competing demands
• Proficiency with Microsoft Office applications, including Word, Excel, and Power Point
• Ability to adapt to changing business needs and work effectively in a dynamic environment

• Bachelor of Science in Nursing (BSN)
• Certified Case Manager (CCM) designation
• Experience supporting disability, absence management, or insurance-based claims operations
• Knowledge of disability products, business rules, and claims procedures
• Experience with DCMS, Claim Facts, iProcess, or similar claims management systems

• Review short-term and long-term disability claims to evaluate medical documentation, functional limitations, treatment progress, and expected recovery timelines.
• Analyze the impact of illness, injury, and treatment plans on a claimant’s ability to perform occupational and daily living activities, providing clinical recommendations that support claim decisions.
• Collaborate with treating providers, claimants, case managers, and vocational rehabilitation specialists to promote appropriate treatment plans, clarify medical information, and facilitate return-to-work opportunities.
• Serve as a clinical subject matter expert by educating claims professionals on medical conditions, treatment interventions, functional impairments, and disability-related outcomes.
• Coordinate independent medical reviews and assessments, ensuring quality, accuracy, and timely resolution of complex clinical questions.
• Manage a high-volume workload while prioritizing customer needs, resolving issues proactively, and supporting continuous quality improvement initiatives.
• Provide ongoing mentoring and training to claims staff and peers regarding the medical and functional impact of injury, illness, and treatment on disability claims.

• As our RN Clinical Consultant , you will report to our Clinical Team Leader , who reports to our Director, Clinical Services
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• Plano,…