Relocation Yes

Location South Portland ME

Company has an excellent opportunity for a clinical professional. This

position requires the incumbent to be fluent in Spanish and English.

Principal Objective:

Contribute to and support company's approach to disability management by

assessing, clarifying and developing medical issues to assist in determining

eligibility and assessing functionality for individuals applying for and

receiving disability benefits ensuring effective optimum outcomes and

quality customer service.

Dimensions/Scope of Position:

Accounts and authority levels are defined by Claims Manager and are directly

related to training and experience. Duties include medical assessment of

claims as well as ongoing case management when appropriate.

Clinical Care Manager Trainee - Under immediate supervision, assesses

medical issues and functionality to clarify eligibility for benefits and

provide case management strategies.

Clinical Care Manager - Under general supervision, assesses medical issues

and functionality to clarify eligibility for benefits and provide case

management strategies.

Senior Clinical Care Manager - Under general supervision, partners with

other clinical care managers in the mentor program. Thinks strategically as

to the direction of the clinical team's direction. assesses medical issues

and functionality to clarify eligibility for benefits and provide case

management strategies. Has at least 5-8 years disability insurance

experience.

Essential Duties/Responsibilities:

1) Conduct comprehensive clinical assessments of short and long term

disability claims that are referred and provide feedback as to how medical

findings relate to functionality. Obtain information by phone contact to

physician, employee, employer or others. Provide guidance to other staff in

obtaining such.

2) Assist with determining eligibility for benefits by assessing

pre-existing issues.

3) Provide ongoing clinical case management with three-point contact to

employee, employer and physician when appropriate to facilitate optimum

claim resolutions.

4) Act as a Team Resource and participate by answering questions regarding

medical issues and functionality and provide clear and complete clinical

recommendations for short and long-term goals at team meetings.

5) Manage IME and Peer to Peer referrals and analysis of results by

reviewing appropriateness and timeliness of evaluation. Provide

interpretation and documentation of results when completed.

6) Using network resources, direct vendor services and activities on

referrals by outlining and communicating specific service requests and

ensuring service quality and correlated expenses.

7) Provide or coordinate in service training to claim and rehabilitation

staff to enhance staff knowledge. Provide information to staff on what

clinical resources are available.

8) Provide sales/service support internally and to employers and client

companies through questionnaires, presentations and reports.

9) Keep abreast of current medical technology and utilize such when able.

10) Document claim files and systems in the approved format and in a clear,

consistent and professional manner.

11) Identify cases with potential for changes in outcome plan.

12) Maintain a level of participation and commitment to individual, team,

client companies, and company results. Note any trends that may be effecting

liability and advise appropriate parties of such. Keep abreast of policy

provisions and language on accounts serviced.

Job Requirements

Job related requirements include a proficiency in oral and written

communication. Must be fluent in Spanish and English with the ability

read, write and speak both languages. Assessments, problem solving, plan

development and implementation skills are essential. Incumbent must possess

sufficient knowledge and understanding of CPT and ICD-9 coding as care

managers may be responsible for correctly coding to reflect the medical

information within various claim systems on cases referred.

Competencies desired:

Ability to quickly establish rapport with all levels of employees and

customers.

Excellent communication/verbal skills

Ability to Multi-task and quickly make accurate and appropriate decisions.

Have Strong LTD experience with variety of impairment knowledge.

Education Requirements

Qualifications:

This position requires incumbents to be licensed registered nurses whose

expertise meets the current needs of the clinical team. Clinical Care

Consultants must hold current licenses, registrations, and/or any

professional designations that may be required within the jurisdiction. It

is required that all of our clinical care consultants keep their clinical

area of expertise current and acquire the necessary continuing education

credits to keep his/her license, designation and/or certification current.

Senior Clinical Care Managers must possess one or more related

certifications such as (Certified Rehabilitation Registered Nurse, Certified

Case Manager, etc.).

They would prefer to have someone that currently works on disability

business if we can find that experienced.

MUST HAVE (FIRM)

1. Licensed RN.

2. Bilingual English Spanish.

3. Strong Long Term Disability experience with variety of impairment

knowledge.

4. Senior Clinical Care Managers must possess one or more related

certifications such as Certified Rehabilitation Registered Nurse, Certified

Case Manager, etc.

5. They would prefer to have someone that currently works on disability

business if we can find that experienced.

Send resume to: managerglobalsystems.ws