Clinical Review Nurse Disability Claims
Clinical Review Nurse Disability Claims
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Job Description
At Equitable our power is in our people. Were individuals from different cultures and backgrounds. Those differences make us stronger as a team and a force for good in our communities. Here youll work with dynamic individuals build your skills and unleash new ways of working and thinking. Are you ready to join an organization that will help unlock your potential
Equitable is seeking a Clinical Review Nurse to join our Group Disability Claims team. The Clinical Review Nurse plays a crucial role in the disability claims process by conducting thorough clinical reviews of medical documentation related to disability claims. This position focuses on evaluating medical information to provide insights and recommendations but does not involve the adjudication or final decisionmaking on claims. The role requires strong clinical knowledge attention to detail and effective communication skills to collaborate with various stakeholders.
Key Job Responsibilities
- Clinical Evaluation:
- Review and analyze medical records and documentation to assess the medical aspects of disability claims.
- Identify any missing or incomplete information and recommend additional documentation if necessary.
- Review and analyze medical records and documentation to assess the medical aspects of disability claims.
- Collaboration:
- Work closely with disability adjudicators and case managers to provide clinical insights and support.
- Communicate with healthcare providers to clarify medical information and ensure comprehensive understanding.
- Work closely with disability adjudicators and case managers to provide clinical insights and support.
- Documentation:
- Prepare detailed clinical summaries and reports based on the reviewed medical information.
- Maintain accurate records of all clinical reviews and interactions.
- Prepare detailed clinical summaries and reports based on the reviewed medical information.
- Communication:
- Serve as a clinical resource for claims specialists offering explanations of medical findings and implications.
- Liaise with internal departments to ensure seamless processing of claims.
- May require reach out to attending physician or other medical provider for clarification of conditions and treatment.
- Serve as a clinical resource for claims specialists offering explanations of medical findings and implications.
- Compliance:
- Ensure all clinical reviews adhere to company policies legal standards and regulatory requirements.
- Stay updated on relevant medical guidelines and disability insurance regulations.
- Ensure all clinical reviews adhere to company policies legal standards and regulatory requirements.
The base salary range for this position is $60000 $80000. Actual base salaries vary based on skills experience and geographical location. In addition to base pay Equitable provides compensation to reward performance with base salary increases spot bonuses and shortterm incentive compensation opportunities. Eligibility for these programs depends on level and functional area of responsibility.
For eligible employees Equitable provides a full range of benefits. This includes medical dental vision a 401(k) plan and paid time off. For detailed descriptions of these benefits please reference the link below.
Equitable Pay and Benefits: Equitable Total Rewards Program
Required Qualifications
- 5 years of professional clinical experience
- Hands on experience in clinical reviews or medical case management
- Experience with group insurance and/or disability claims
Preferred Qualifications
- Bachelors degree in nursing or a related field
- Registered Nurse (RN) with a valid nursing license
- Experience and familiarity with behavioral health conditions treatment and claims highly desired
- Strong analytical and critical thinking skills
- Excellent written and verbal communication abilities
- Proficiency in medical terminology and understanding of various medical conditions
- Ability to work independently and as part of a multidisciplinary team
Skills
Crossfunctional Collaboration: Knowledge of collaborative techniques and approaches; ability to promote a culture of continuous improvement and working together across functions to solve business problems and meet business goals.
Decision Making and Critical Thinking: Knowledge of the decisionmaking process and associated tools and techniques; ability to accurately analyze situations and reach productive decisions based on informed judgment.
Requirements Analysis: Knowledge of tools methods and techniques of requirement analysis; ability to elicit analyze and record required business functionality and nonfunctionality requirements to ensure the success of a system or software development project.
Medical Writing/Documentation: Proficiency in medical terminology and understanding of various medical conditions.
ABOUT EQUITABLE
At Equitable were a team committed to helping our clients secure their financial wellbeing so that they can pursue long and fulfilling lives.
We turn challenges into opportunities by thinking working and leading differently where everyone is a leader. We encourage every employee to leverage their unique talents to become a force for good at Equitable and in their local communities.
We are continuously investing in our people by offering growth internal mobility comprehensive compensation and benefits to support overall wellbeing flexibility and a culture of collaboration and teamwork.
We are looking for talented dedicated purposeful people who want to make an impact. Join Equitable and pursue a career with purpose.
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Equitable is committed to providing equal employment opportunities to our employees applicants and candidates based on individual qualifications without regard to race color religion gender gender identity and expression age national origin mental or physical disabilities sexual orientation veteran status genetic information or any other class protected by federal state and local laws.
NOTE: Equitable participates in the EVerify program.
If reasonable accommodation is needed to participate in the job application or interview process or to perform the essential job functions of this position please contact Human Resources ator email us at.
Employment Type
Full-Time
