Position Summary
The RN Clinical Consultant plays a critical role in evaluating long-term disability (LTD) claims by assessing medical evidence, identifying functional impairments, and providing clinical insight to support accurate and timely claims decisions. Acting as a clinical advisor, you will collaborate with healthcare providers, claimants, vocational rehabilitation specialists, and claims teams to promote optimal treatment outcomes and return-to-work (RTW) planning. This position emphasizes proactive engagement, clinical expertise, and a strong commitment to customer service.
Key Responsibilities
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Conduct comprehensive clinical reviews of LTD claims, analyzing medical records, diagnoses, treatments, and functional capacity.
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Assess restrictions, limitations, and impairments to determine their impact on the claimant’s ability to work.
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Proactively engage with claimants and healthcare providers to gather, clarify, and validate medical information.
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Evaluate current treatment plans and collaborate with providers to ensure appropriate care and accountability.
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Partner with vocational rehab teams to identify RTW opportunities and support claimant recovery plans.
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Serve as a subject matter expert on clinical matters for claim managers and internal teams.
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Develop clear, concise documentation and recommendations to support claim outcomes.
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Educate internal stakeholders on clinical conditions, treatment expectations, and functional impacts.
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Facilitate independent medical evaluations and ensure quality of third-party assessments.
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Demonstrate empathy, professionalism, and strong customer-centric communication throughout all interactions.
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Manage a dynamic caseload, prioritize tasks, and contribute to continuous process improvement.
Required Qualifications
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Education & Licensure:
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Registered Nurse (RN) from an accredited nursing program.
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Active, unrestricted RN license in good standing.
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Experience:
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Minimum 5 years of clinical nursing experience, with at least 2 years in an acute care setting.
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Prior experience in disability case management strongly preferred.
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Skills:
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Excellent verbal and written communication and documentation skills.
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Strong clinical judgment and critical thinking abilities.
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Proven organizational, time management, and multitasking skills.
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Comfort working independently and collaboratively in a remote environment.
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High proficiency with computer systems and internet-based research.
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Detail-oriented with strong analytical capabilities.
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Certifications:
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Certified Case Manager (CCM) preferred.
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Leadership Expectations
Guardian expects all team members to model ethical business practices, maintain collaborative and respectful relationships, and deliver exceptional service. RN Clinical Consultants are also expected to lead by example and demonstrate a commitment to professional excellence and continuous improvement.
What Guardian Offers
As part of Guardian’s mission to inspire well-being, employees enjoy a supportive, inclusive, and flexible work environment. Benefits for eligible full-time employees include:
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Medical, dental, and vision coverage
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Life and disability insurance
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401(k) with company match
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Paid time off and holidays
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Professional development and leadership programs
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Tuition reimbursement
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Community engagement opportunities