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Disability Clinical Specialist
PRIMARY PURPOSE : To perform clinical evaluations, consult providers and employees; to provide case direction; and to ensure medical information substantiates the need for absence from work.

EDUCATION & LICENSING

Bachelor’s degree or equivalent preferred. RN or CRC a must. Current license, registration and/or professional designations as required within the jurisdiction. Clinical expertise must be kept current by acquisition of the necessary CEUs to maintain licenses and designations.

EXPERIENCE

Four (4) years of related experience or equivalent combination of education and experience required to include experience in a direct medical/psychological setting or physical industrial medicine and previous insurance experience.

SKILLS & KNOWLEDGE

• Knowledge of current medical practices in health care management in a variety of areas (including, but not limited to, orthopedics, general medicine for acute and chronic conditions, general surgery, mental health, obstetrics, oncology, and physical and occupational rehabilitation)
• Oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Excellent interpersonal skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

• Performs clinical review of referred claims; documents decision rationale; and completes medical review of all claims to ensure information substantiates disability.
• Provides clear and appropriate follow-up recommendations for ongoing medical management of claims; ensures appropriate recommendations are made on claims.
• Makes timely, appropriate contact with employee and/or providers to discuss employee’s clinical status, progress and work status.
• Achieves appropriate quality audit scores on a consistent basis.
• Acts as clinical resource to colleagues within the program.

ADDITIONAL FUNCTIONS AND RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization’s quality program(s).
• Travels as required.