Clinical Consultant
Clinical Consultant
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Job Description
Sun Life U.S. is one of the largest providers of employee and government benefits helping approximately 50 million Americans access the care and coverage they need. Through employers industry partners and government programs Sun Life U.S. offers a portfolio of benefits and services including dental vision disability absence management life supplemental health medical stoploss insurance and healthcare navigation. We have more than 6400 employees and associates in our partner dental practices and operate nationwide.
Job Description:
We are proud to be a hybrid organization that offers our employees the flexibility to work from both the office and virtually based on the needs of the business our Clients and you. This means that if you are within a reasonable commuting distance sometimes you will work in the office and sometimes you will work at home with the frequency of each defined through discussion between you and your manager. Please note that whether you live in a reasonable commuting distance to an office will be determined by Sun Life in its sole discretion. If you do not live within a reasonable commuting distance there may be times that you will need to come into a Sun Life office to participate in events to collaborate or for business continuity purposes. In these instances you will work with your manager to coordinate travel details.
The opportunity:
Sun Life operates with a Work Is Healthy (WisH) approach for disability claims management. As a Clinical Consultant within our Clinical Services team you will apply your clinical expertise as a member of an interdisciplinary team that focuses on returning clients to optimal levels of productivity. This role does not involve handson assessment or direct care. All work is solely performed using electronic medical records and phone/fax communication.
How you will contribute:
Conduct comprehensive clinical assessments of disability claims that are referred in different venues.
Clarifies medical information and/or interprets medical reports (IMEs/FCEs hospital and office records and health care providers (HCP) calls and letters) and evaluates restrictions and limitations to assess current and ongoing level of impairment
Synthesizes pertinent facts and answers questions in collaboration with claims professionals
Meets standards set by management for quality and performance
Applies current clinical knowledge to medical data regarding diagnosis treatment prognosis and impairment
Participates proactively through early assessment of medical conditions functional capacity and return to work (RTW) opportunities
Provides whole person analysis documenting rationale for opinions and recommended next steps
Makes appropriate decisions and takes action as indicated to obtain additional medical information and/or referral to the appropriate resource such as physician claims professional or vocational resource
Provides input and assistance to identify and collect pertinent medical information through outreach communications with attending physicians claimants/insureds and employers
Demonstrates excellent verbal and written communication to gather and report information
Effectively and accurately educates attending physicians and other health care providers about Sun Lifes WisH program
Operates with urgency to support claims professionals to determine claim direction and facilitate next steps
Outreach to health care provider (HCP) insured or as indicated to discuss complex medical issues and document outcomes of discussion
Coordinates with Vocational Rehabilitation Consultant (VRCs) and others in regard to return to work services
Evaluates each claim file for RTW opportunities and partners with the VRC to develop RTW plans as indicated
Evaluates claims for potential accommodations or partial RTW
Partner with VRC to identify functional capabilities for alternative occupations/job duties
Provides consultation and education to peers and a variety of other business partners
Demonstrates knowledge skill and problem solving in communicating effectively with both internal customers and with external resources
Works collaboratively with clinical and claims professionals to improve disability claim management practices
Provides clinical input in claims meetings and leads discussions to facilitate appropriate clinical intervention
Provides training and mentoring to new clinical vocational claims and other staff as appropriate. May provide training to groups of peers and/or claims professionals to update their knowledge/skills
What you will bring with you:
RN licensure active and unrestricted BSN preferred
Specialty certification such as CCM CRRN or eligible with desire to pursue a plus
Minimum of 3 years clinical experience working with an adult working age population
Experience in a rehabilitation setting Occupational Health Case/Care Management Disability Insurance Group Benefits or Workers compensation a plus
Ability to communicate effectively and professionally with a wide variety of both internal and external Sun Life business partners peers and resources
Attention to detail with documentation reporting and communication
Facilitation skills in a variety of circumstances and with a wide variety of input. Ability to influence and teach
Selfdirected with an ability to work independently and make independent judgments and decisions
Strong organizational skills including the ability to prioritize work and multitask
Strong research analytical critical thinking problem solving skills and decisionmaking skills
Ability to thrive in a fastpaced serviceoriented environment
Strong computer skills proficient in PC environment and MS Word Excel and email systems
A drive to continuously learn build and grow professionally
Salary:
$77400 $116100
At our company we are committed to pay transparency and equity. The salary range for this role is competitive nationwide and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills qualifications experience education and geographic location. In addition to your base salary this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.
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We are committed to fostering an inclusive environment where all employees feel they belong are supported and empowered to thrive. We are dedicated to building teams with varied experiences backgrounds perspectives and ideas that benefit our colleagues clients and the communities where we operate. We encourage applications from qualified individuals from all backgrounds.
Life is brighter when you work at Sun Life
At Sun Life we prioritize your wellbeing with comprehensive benefits including generous vacation and sick time marketleading paid family parental and adoption leave medical coverage company paid life and AD&D insurance disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match stock purchase options and an employerfunded retirement account. Enjoy a flexible inclusive and collaborative work environment that supports career growth. Were proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S. weve also been recognized as a Top 10 employer by the Boston Globes Top Places to Work for two years in a row. Visit our website to learn more about our benefits and recognition within our communities.
We will make reasonable accommodations to the known physical or mental limitations of otherwisequalified individuals with disabilities or special disabled veterans unless the accommodation would impose an undue hardship on the operation of our business. Please email to request an accommodation.
For applicants residing in California please read our employee California Privacy Policy and Notice.
We do not require or administer lie detector tests as a condition of employment or continued employment.
Sun Life will consider for employment all qualified applicants including those with criminal histories in a manner consistent with the requirements of applicable state and local laws including applicable fair chance ordinances.
All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin disability or status as a protected veteran.
Job Category:
Posting End Date:
Required Experience:
Contract
Employment Type
Full-Time
