Clinical Specialist

Job Description – Clinical Specialist     Position Summary As a Clinical Specialist, you will use your practical or vocational nursing experience and knowledge of medical and behavioral health conditions to support timely disability claim decisions. You will identify and obtain certification dates, treatment plans, functional limitations, and other pertinent medical information from claimants and treating providers. You will partner with Claims Case Managers, claimants, providers, and vendors to facilitate efficient medical outreach and collection of information. You may also coordinate vendor utilization and help assess overall function as business needs require. You are You are a licensed Practical or Vocational Nurse who applies sound clinical judgment, communicates clearly, and works independently in a fast-paced environment. You are organized, adaptable, and comfortable managing changing priorities while collaborating with claim professionals, claimants, treating providers, vendors, and multiple professional disciplines. You are committed to maintaining current medical knowledge, delivering responsive customer service, and documenting accurate, concise information that supports timely claim decisions. You have   Preferred Qualifications:   Experience supporting disability claims, medical case management, or a related insurance function Experience obtaining and reviewing medical documentation from treating providers LPN or LVN from an accredited school of nursing with a valid license in good standing Minimum of two years of clinical experience or equivalent medical office experience Excellent written and verbal communication skills Ability to exercise independent and sound judgment in decision-making Excellent time-management, organizational, prioritization, and multitasking skills Self-motivated and able to work independently and collaboratively with multiple professional disciplines and diverse populations Current medical knowledge maintained through continuing education Basic computer proficiency, including Microsoft Office and OneNote   You will Review claim file information and obtain necessary medical documentation, including disability certification, treatment plans, functional limitations, and restrictions from treating providers Use medical knowledge to identify missing or pertinent information needed to support disability claim adjudication Document clear and concise details regarding certification dates, treatment plans, functional information, and other relevant claim information Collaborate with Claims Case Managers, claimants, and treating providers to facilitate timely outreach and collection of medical information Support vendor management by coordinating services, scheduling, following up on vendor reports, and assisting with vendor utilization as needed Remain flexible to changing business needs and assist the team in meeting customer and departmental requirements   Reporting Relationships As our Clinical Specialist, you will report to the Clinical Specialist Team Leader, who reports to the Head of Disability Clinical and Vocational Organization. Location This is a mobile position where preference may be given to candidates within commuting proximity to a Guardian office with the ability to travel to Guardian offices as determined by the People Leader.    Salary Range: $59,110.00 - $88,660.00 The salary range reflected above is a good faith estimate of base pay for the primary location of the position. The salary for this position ultimately will be determined based on the education, experience, knowledge, and abilities of the successful candidate. In addition to salary, this role may also be eligible for annual, sales, or other incentive compensation. Our Promise At Guardian, you’ll have the support and flexibility to achieve your professional and personal goals.  Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities