Disability Clinical Specialist

2 weeks ago

Dubuque, Iowa, United States Access Dubuque Full time
Job Title: Disability Clinical Specialist

We are seeking a highly skilled Disability Clinical Specialist to join our team. As a Disability Clinical Specialist, you will be responsible for performing clinical evaluations, consulting with providers and employees, and providing case direction to ensure medical information substantiates the need for absence from work.

Key Responsibilities:
  • Perform clinical review of referred claims, document decision rationale, and complete medical review of all claims to ensure information substantiates disability.
  • Provide clear and appropriate follow-up recommendations for ongoing medical management of claims, ensuring 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.
Requirements:
  • Bachelor's degree or equivalent preferred. RN, & LPN's preferred. Current license, registration, and/or professional designations as required within the jurisdiction.
  • 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.
  • 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.
Work Environment:

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.

Physical: Computer keyboarding, travel as required.

Auditory/Visual: Hearing, vision, and talking.

NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.

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