RN Clinical Consultant

Overview

Clinical consultant role supporting the evaluation of short-term and long-term disability claims as a registered nurse clinical expert, analyzing medical information and providing clinical guidance that supports claim decisions.

What you'll do

• Review short-term and long-term disability claims to evaluate medical documentation, functional limitations, treatment progress, and expected recovery timelines.
• Analyze the impact of illness, injury, and treatment plans on a claimant's ability to perform occupational and daily living activities, providing clinical recommendations that support claim decisions.
• Collaborate with treating providers, claimants, case managers, and vocational rehabilitation specialists to promote appropriate treatment plans, clarify medical information, and facilitate return-to-work opportunities.
• Serve as a clinical subject matter expert by educating claims professionals on medical conditions, treatment interventions, functional impairments, and disability-related outcomes.
• Coordinate independent medical reviews and assessments, ensuring quality, accuracy, and timely resolution of complex clinical questions.
• Manage a high-volume workload while prioritizing customer needs, resolving issues proactively, and supporting continuous quality improvement initiatives.
• Provide ongoing mentoring and training to claims staff and peers regarding the medical and functional impact of injury, illness, and treatment on disability claims.

What you'll need

• Active Registered Nurse (RN) license.
• Minimum of 5 years of direct acute patient care experience.
• Minimum of 3 years' experience as a clinical consultant in LTD and/or STD (LTD preferred).
• Strong knowledge of medical conditions, treatments, and their impact on functional capacity and disability duration.
• Excellent verbal and written communication skills.
• Strong clinical assessment, analytical, critical thinking, and research skills.
• Ability to exercise independent judgment and make sound clinical decisions.
• Strong organizational and time-management skills with the ability to prioritize competing demands.
• Proficiency with Microsoft Office applications, including Word, Excel, and PowerPoint.
• Ability to adapt to changing business needs and work effectively in a dynamic environment.

Nice to have

• Bachelor of Science in Nursing (BSN).
• Certified Case Manager (CCM) designation.
• Experience supporting disability, absence management, or insurance-based claims operations.
• Knowledge of disability products, business rules, and claims procedures.
• Experience with DCMS, Claim Facts, iProcess, or similar claims management systems.

Details

• Location: Plano, TX; Bethlehem, PA; Holmdel, NJ; or fully remote.
• Travel: occasional, 0-10% of the time.
• Reports to the Clinical Team Leader, who reports to the Director, Clinical Services.
• Must be legally authorized to work in the United States without employer sponsorship now or in the future.