RN Clinical Consultant

Fully Remote

Remote - United States

Full time

R

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
• Minimumof5yearsofdirect acutepatientcareexperience
• Minimum of 3 years' experience as a clinical consultant in LTD and/or STD (LTD preferred)
• Strongknowledgeofmedicalconditions,treatments,andtheirimpactonfunctionalcapacityanddisabilityduration
• Excellentverbalandwrittencommunicationskills
• Strongclinicalassessment,analytical,critical thinking,andresearchskills
• Abilitytoexerciseindependentjudgmentandmakesoundclinicaldecisions
• Strongorganizationalandtime-managementskillswiththeabilitytoprioritizecompetingdemands
• Proficiency with Microsoft Office applications ,including
  
  Word,Excel,andPower Point
• Abilitytoadapttochangingbusinessneedsandworkeffectivelyinadynamicenvironment

• Bachelor of Sciencein Nursing (BSN)
• Certified Case Manager (CCM) designation
• Experiencesupportingdisability,absence management,or insurance-basedclaimsoperations
• Knowledgeofdisabilityproducts,business rules,andclaimsprocedures
• ExperiencewithDCMS,Claim Facts,iProcess,orsimilarclaimsmanagementsystems

• Review short-termandlong-termdisabilityclaimstoevaluatemedicaldocumentation,functional limitations,treatment progress,andexpectedrecoverytimelines.
• Analyzetheimpactofillness,injury,andtreatmentplansonaclaimant’sabilitytoperformoccupationalanddailylivingactivities,providingclinicalrecommendationsthatsupportclaimdecisions.
• Collaboratewithtreatingproviders,claimants,case managers,andvocationalrehabilitationspecialiststopromoteappropriatetreatmentplans,clarifymedicalinformation,andfacilitatereturn-to-work opportunities.
• Serveasaclinicalsubjectmatterexpertbyeducatingclaimsprofessionalsonmedicalconditions,treatment interventions,functional impairments,and disability-related outcomes.
• Coordinateindependentmedicalreviewsandassessments,ensuring quality,accuracy,andtimelyresolutionofcomplexclinicalquestions.
• Manageahigh-volumeworkloadwhileprioritizingcustomerneeds,resolvingissuesproactively,andsupportingcontinuousqualityimprovementinitiatives.
• Provideongoingmentoringandtrainingtoclaimsstaffandpeersregardingthemedicalandfunctionalimpactofinjury,illness,andtreatmentondisabilityclaims.

• Asour RN Clinical Consultant ,youwillreporttoour Clinical Team Leader ,whoreportstoour Director, Clinical Services .

• Plano, TX, Bethlehem, PA, Holmdel, NJ, or fully remote

• Occasional 0-10% of the time.

$68,970.00 - $

The salary range reflected above is a good faith estimate of base pay for the primary location of…