Website Lincoln Financial Group
As an Appeals Nurse Disability Claims Consultant, you will be responsible for reviewing, analyzing and interpreting medical information available in Group Protection claims. You will be evaluating medical information to clarify diagnoses, evaluating the severity of medical conditions, validating medical restrictions and limitations and estimating duration of recovery. As an Appeal Nurse Disability Consultant, you will act as clinical resource for Group Protection benefit specialists and appeal professionals.
- Coordinates and partners with Vocational Rehabilitation Coordinators (VRC) and others to support return to work services.
- Makes appropriate referrals to independent and external clinical resources (i.e. IME, FCE, Peer Reviews).
- Discusses complex medical issues with health care providers as needed and documents outcomes of discussion.
- Clarifies, interprets and/or evaluates medical information to assess appropriateness of current and ongoing restrictions / limitations and level of impairment.
- Identifies pertinent clinical facts and answers questions in collaboration with appeal professionals and physician consultants.
- Effectively manages assigned caseload within department productivity goals
- Acts as a clinical resource to Group Protection appeal professionals during claim meetings and as needed.
- Proficient in Microsoft applications including Word, Excel, PowerPoint, and Outlook. Typing is proficient and accurate and at least average speed
- Drives performance targets to completion
- A demonstrated track record of consistently meeting and/or exceeding performance expectations
- Previous insurance industry experience preferred
- Possesses a bias for action and avoids workplace distractions
- 3-5 years of nursing experience with preferred clinical nursing expertise in Emergency Room, Critical Care, Orthopedics, Coronary Care, or trauma.
Qualification & Experience:
- Current unrestricted RN License in the state where the position is based required
- Certified Disability Management Specialist (CDMS) or Associate Disability Management Specialist (ADMS), Certified Occupational Health Nurse (COHN), Certified Case Manager (CCM) designations preferred
- Educational experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred
- 4 Year/Bachelor’s Degree in Nursing preferred
Company: Lincoln Financial Group
Vacancy Type: Full Time
Job Location: Dover, NH, US
Application Deadline: N/A