Long Term Care Clinical Nurse Consultant
我们正在寻求一个熟悉和详细的临床护士顾问长期照顾，通过全面的医疗审查，临床分析以及返工和恢复指导提供临床专业知识和支持索赔管理。在这个角色中，你将评估与索赔有关的医学信息，确定适当的限制和局限性，并提出建议来支持有效的索赔结果和恢复机会。理想的候选人结合强大的临床判断，分析技能和承诺质量保健的能力，培养索赔专业人士，与商业合作伙伴合作，监测供应商绩效。· 基本工资：74,800美元 - 100,000美元，加上年度奖励机会。· 401 (k) 计划与2%的公司贡献和6%的公司匹配。· 与假期，个人时间和有薪休息的工作生活平衡。详细阅读我们的福利和优惠页。· 本职位申请人不得现在或将来任何时候都要求获得就业赞助。· 你会做什么？· 医学审查和临床评估：分析，解释和验证医疗记录和报告；确定限制和限制；确定恢复时间表；建议下一步；并支持适当的索赔决策和案件管理战略。· 供应商和资源管理：协调和监督残疾案件管理及长期护理评估服务，评价质量和结果，确定成本节约以及维护全国范围内可用的服务和资源数据库。·沟通与合作：与索赔者，家庭，医生，医疗设施，律师，保险公司，雇主和其他利益相关方合作获取并澄清医学信息，解释政策益处，制定护理计划，解决复杂的医疗条件。·临床咨询和风险管理：建议外部医疗咨询，评估替代保健选择，就适当的医疗处理提供建议，支持法律程序，并向管理层介绍服务质量，资源效率和风险减轻。· 教育与持续改善：为索赔人员开展临床培训，保持行业趋势和最佳实践的最新信息，参加专业研讨会，制定创新护理计划以提高结果，增加价值和控制成本。
查看英文原文
We are seeking a knowledgeable and detail-oriented Clinical Nurse Consultant – Long-Term Care to provide clinical expertise and support claims management through comprehensive medical reviews, clinical analysis, and return-to-work and recovery guidance. In this role, you will evaluate medical information related to claims, identify appropriate restrictions and limitations, and provide recommendations that support effective claim outcomes and recovery opportunities.
The ideal candidate combines strong clinical judgment, analytical skills, and a commitment to quality care with the ability to educate claims professionals, collaborate with business partners, and monitor vendor performance.
WHAT WE CAN OFFER YOU:
- Base Salary: $74,800 - $100,000, plus annual bonus opportunity.
- 401(k) plan with a 2% company contribution and 6% company match.
- Work-life balance with vacation, personal time and paid holidays. See our benefits and perks page for details.
- Applicants for this position must not now, nor at any point in the future, require sponsorship for employment.
WHAT YOU'LL DO:
- Medical Review and Clinical Assessment: Analyze, interpret, and validate medical records and reports; identify restrictions and limitations; determine recovery timelines; recommend next steps; and support appropriate claim decisions and case management strategies.
- Vendor and Resource Management: Coordinate and monitor disability case management and long-term care assessment services, evaluate quality and outcomes, identify cost savings, and maintain a nationwide database of available services and resources.
- Communication and Collaboration: Partner with claimants, families, physicians, medical facilities, attorneys, insurers, employers, and other stakeholders to obtain and clarify medical information, explain policy benefits, develop care plans, and address complex medical conditions.
- Clinical Consultation and Risk Management: Recommend external medical consultations, evaluate alternative care options, advise on appropriate medical handling, support legal proceedings, and inform management about service quality, resource effectiveness, and risk mitigation.
- Education and Continuous Improvement: Develop and deliver clinical training for claims associates, stay current on industry trends and best practices, participate in professional seminars, and develop innovative care programs to improve outcomes, add value, and control costs.
WHAT YOU’LL BRING:
- Education and Licensure: Licensed Registered Nurse (RN) with knowledge or experience in disability case management, elder care, long-term care, critical illness, early intervention, treatment mechanisms, claims procedures, or related areas. Bachelor of Science degree preferred; an associate degree with relevant credentials or experience will be considered.
- Clinical and Analytical Expertise: Demonstrates sound judgment, initiative, creativity, critical thinking, strong analytical and problem-solving skills, and confident decision-making abilities.
- Communication and Collaboration: Possesses excellent written and verbal communication, interpersonal, facilitation, and organizational skills, with the ability to work effectively in a fast-paced, team-oriented corporate environment.
- Adaptability and Workload Management: Works independently, manages multiple cases and deadlines, navigates multiple business systems, adapts to changing priorities, learns new insurance products and procedures, and is willing to travel up to 25% of the time.
- Customer Focus and Regulatory Compliance: Prioritizes customer needs while ensuring high-quality, timely, and compliant claim decisions, with knowledge of insurance policy language, provisions, and applicable regulations, including ERISA.
- You promote a collaborative culture, value different ideas and opinions, and listen courageously, remaining curious in all that you do.
- Able to work remotely with access to a high-speed internet connection and located in the United States.
PREFERRED:
· Bachelor's Science Nursing (BSN) is preferred
We value unique experience, skills, and passion for innovation. If your experience aligns with the listed requirements, please apply!
If you have questions about your application or the hiring process, email our Talent Acquisition area at . Please allow at least one week from time of applying if you are checking on the status.
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Salary: C23 | Pay Scale: 110 C23 - AnnualOriginally posted on Himalayas