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OneAmerica - Indianapolis, IN
posted 3 days ago
About the position
The Clinical Care Consultant is responsible for conducting comprehensive clinical assessments and claim recertifications of long-term care claims and provides feedback as to how medical findings relate to functionality. This includes reviewing medical records, medical reports, cognitive testing results, etc. Documentation and summary are required for each assessment. The role also involves staying up-to-date with current medical technology and advising on potential changes in claim processes. Additionally, the consultant will provide or coordinate in-service training for claims staff.
Responsibilities
- Conduct comprehensive clinical assessments and claim recertifications of long-term care claims.
- Review medical records, medical reports, and cognitive testing results.
- Provide feedback on how medical findings relate to functionality.
- Document and summarize each assessment.
- Stay up-to-date with current medical technology and advise on changes in claim processes.
- Provide or coordinate in-service training to claims staff.
- Ensure effective, accurate, and timely communication with internal and external customers.
- Maintain or exceed departmental deadlines and performance standards.
- Identify opportunities for efficiency and innovation in processes.
Requirements
- Must be a Licensed Registered Nurse with current licensure in the state of residency and employment.
- Long Term Care experience highly preferred; may consider disability or health experience.
- Insurance industry experience required.
- Any combination of education and experience that provides an equivalent background.
