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2 positions one in Brooklyn Park, MN and one in Lincolnshire, IL
A global leader in human capital consulting and outsourcing solutions. The company partners with organizations to solve their most complex benefits, talent and related financial challenges, and improve business performance. We designs, implements, communicates and administers a wide range of human capital, retirement, investment management, health care, compensation and talent management strategies. With more than 29, 000 professionals in 90 countries, Clinical Case Managers examine Disability Pension and/or FMLA, STD (Short term disability), and/or LTD (Long term disability) claims from a medical and contractual standpoint and serve as a medical resource and consultant to case managers to assess functionality based on medical evidence.
Review and evaluate disability claims to determine level of functioning based on knowledge of current medical standards of care and knowledge of the employer and the employee's job requirements, as well as the plan's definition of disability.
Resolve inconsistencies in the level of functioning.
Coordinate a strategy to determine true level of functionality.
Review claims from a medical perspective to determine if medical evidence supports disability based on contractual provisions.
Document disability status and assessment to include medical, contractual, and vocational information.
Triage disability claims into appropriate claim management tracks (system-generated changes made during clinical case review).
Act as medical consultant to Appeals Unit.
Coordinate and monitor quality of Independent Medical Exams (IME's) and Functional Capacity Exams (FCE's).
Coordinate internal physician consultant referrals by using supporting clinical resources and vocational resources.
Identify barriers for employees to return to work as well as identifying appropriate (optimal) health care, rehabilitation and work to facilitate an early and safe return to work.
Communicate effectively with employers, employees, and health care providers.
Manage daily relations with assigned accounts and key contacts.
Upon account requirements and upper management request, visit clients for new account implementation and maintenance of existing accounts.
Seek and maintain current profession credentials, and engage in continuous medical education
Qualifications
Extensive medical knowledge.
Strong investigative and analytical skills.
Strong customer service skills.
Strong written and oral communication skills.
Strong organizational and time management skills.
Ability to assess medical records.
Work in team environment.
Education and Experience:
Mandatory Experience
Associates or Bachelors degree in Nursing.
Must hold current licenses, registrations, and/or professional designations required within the jurisdiction.
Five years of experience in clinical care areas of nursing or occupational health.
Desired Experience
Be a registered nurse.
2-3 years of disability case review or case management experience.
CCM, CDMS, and COHN designations.
All positions require an applicant who has accepted an offer to undergo a background check. The checks run are based on the nature of the position. Background checks may include some or all of the following: education verification, employment verification, criminal check, Denied Restricted Parties Lists or OFAC lists check, fingerprint verification, credit check, and/or drug test.
2+ to 5 years of experience
Management Experience Required - No
Minimum Education - Bachelor's Degree
Willingness to Travel - Occasionally
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