Nurse Consultant Job Description: Supports the Claim Operation by providing clinical expertise to the timely analysis of the medical information in order to determine the claimant’s functional ability and prognosis for return to work. Clinically manages appropriate claims with a return to work focus.
Requirements and Qualifications of Nurse Consultant Job:
- Nursing degree with a current state RN license.
- 3 + years of experience in clinical nursing, working with an adult population
Key Competencies, Qualifications, and Skills Preferred:
- Additional Licensure-Certified Case Manager, AHIP designation, etc. preferred.
- Disability insurance or workers compensation case management, private rehabilitation risk management, occupational health, or rehabilitation facility is highly preferred.
- Must possess excellent verbal and written communication skills with both internal and external customers.
- Must possess excellent analytical decision-making and problem-solving skills.
- Must be able to prioritize work and meet deadlines.
- Ability to work independently and in a team environment.
- Ability to engage in effective conflict resolution.
- Ability to work effectively with various levels throughout the company and with external customers.
- Knowledge of medical terminology and procedures required.
- Proficient in the use of multiple systems and technology resources.
Nurse Consultant Functional Responsibilities:
- Manages assigned caseload of complex cases; applies specialized training/knowledge to the assessment of cases; provides technical insight and advice.
- Reviews, records, and analyzes medical records and treatment plans data to make claims settlement determination; compares duration control guidelines and clarifies functional inconsistencies; provides recommendations to the team regarding employee’s current or potential functional abilities; develops goal-focused return-to-work plans; addresses barriers for return to work; facilitates communication between employee, physician and employer and partners with all parties to achieve a positive outcome.
- Follows established claim policies and practices to resolve claims and issues.
- Performs other related duties as assigned or required.
- Works telephonically with claimants, physicians, employers, and customers to ensure strict adherence in determining functional abilities. Responsible for correlating job duties, functional capability, and the definition of disability per contact.
- Assess medical records and treatment plans for all STD/LTD/FML claims, comparing duration control guidelines and clarifying functional inconsistencies in order to determine residual abilities.
- Provides recommendations regarding the claimants’ current or potential functional abilities and develops a goal-focused return to work plan.
- Provides education on medical and disability issues for all STD/LTD/FML Claim Specialists.
- Prepares and implements Return to Work Plans and addresses barriers for return to work for all STD/LTD/FML claims.
- Facilitates communication among employees/physicians/employers and partners with all parties in the medical treatment plan.
- Assesses and facilitates ongoing interventions covering medical, social, psychological, and vocational areas for all STD/LTD/FML claims and refers as appropriate.
- Completes special projects as assigned by the manager.
- Works with management to identify and address continuing education needs.
- Serves as a visible leader in translating MetLife’s vision and values into practical business strategies.
- Demonstrates knowledge of, and supports, MetLife Disability mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality standards, and the code of ethical behavior.
Equal Employment Opportunity
MetLife is a proud equal opportunity/affirmative action employer committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. It is MetLife’s policy to ensure equal employment opportunity without discrimination or harassment based on race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, national origin, marital or domestic/civil partnership status, genetic information, citizenship status, uniformed service member or veteran status, or any other characteristic protected by law.
Job Title Nurse Consultant
Business Category Americas Region
Job Category Claims
Salary Grade 29
Location Tampa, FL
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