Clinical Consultant, CLA

Serve as the department’s primary resource for medical/case management information, including determination of medical conditions, medical restrictions/limitations, and expected duration of medical condition.  Coordinate internal and external investigative requests for all product lines and claim divisions in order for the unit, department, and corporation to meet profitability, service, and performance goals.   ·  Review pertinent facts to aid claims personnel with risk management decisions by clearly defining restrictions/limitations and providing direction to aid in claim specialist liability decisions.·  Interpret medical reports (IME’s, hospital and office records, doctor’s calls and letters) and occupational descriptions to assess extent of impairment.·  Coordinate/assess internal and external investigative requests.  ·  Communicate with claimants, doctors, employers, and others to gather information necessary for claim personnel to make appropriate risk management decisions.·  Work closely with complex claim types or others regarding difficult claims while introducing various case management skills for the specialists. ·  Participate in roundtable/strategy sessions and telephone calls to customers/physicians as needed.·  Conduct medical training classes and coordinate external speakers for on-going medical education, keep medical library updated, obtain current videos with library for at home use.·  Assess/determine whether a file may need review by doctoral consultant(s) and assist in review of medical files. ·  Model and teach case management skills, investigative process, and other job duties, as directed to peers and associate consultants as well as new hires and others.Required:·  10+  years of nursing experience in different fields·  Licensed Registered Nurse·  Organized & detail oriented ·  Ability to manage time efficiently·  Ability to perform in a fast paced, dynamic environment·  Ability to work in a team environment Preferred:·  Certified Case Manager which is obtained by experience, continuous education, and national exam·  Certified Rehabilitation Nurse which is obtained by experience, continuous education, and national exam·  Customer Service experience·  PC/mainframe processing experience·  Prior training experience