Clinical Review Nurse, Disability Claims

Equitable Advisors; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a Clinical Review Nurse to enhance their Group Disability Claims team. This pivotal role involves conducting in-depth clinical evaluations of medical documentation related to disability claims. You will collaborate with adjudicators and case managers, ensuring that all medical insights are communicated effectively. With a focus on compliance and thorough documentation, you will play a key role in the claims process without making final decisions. This opportunity is perfect for individuals looking to leverage their clinical expertise in a dynamic environment that values collaboration and continuous improvement.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401(k) Plan

Paid Time Off

Performance Bonuses

Qualifications

• 5+ years of clinical experience required, preferably in medical case management.
• Strong analytical and communication skills are essential for this position.

Responsibilities

• Review and analyze medical records for disability claims.
• Prepare clinical summaries and communicate findings with stakeholders.

Skills

Clinical Evaluation

Communication Skills

Analytical Skills

Critical Thinking

Cross-functional Collaboration

Education

Bachelor’s degree in nursing

Registered Nurse (RN)

Tools

Medical Documentation

Job description

Job Description - Clinical Review Nurse, Disability Claims (25000067)

Primary Location

UNITED STATES-NC-Charlotte

Other Locations

UNITED STATES-Remote, UNITED STATES-NY-Syracuse

Organization

Equitable

Schedule

Full-time

Description

At Equitable, our power is in our people. We're individuals from different cultures and backgrounds. Those differences make us stronger as a team and a force for good in our communities. Here, you'll work with dynamic individuals, build your skills, and unleash new ways of working and thinking. Are you ready to join an organization that will help unlock your potential?

Equitable is seeking a Clinical Review Nurse to join our Group Disability Claims team. The Clinical Review Nurse plays a crucial role in the disability claims process by conducting thorough clinical reviews of medical documentation related to disability claims. This position focuses on evaluating medical information to provide insights and recommendations but does not involve the adjudication or final decision-making on claims. The role requires strong clinical knowledge, attention to detail, and effective communication skills to collaborate with various stakeholders.

Key Job Responsibilities

• Clinical Evaluation:
  • Review and analyze medical records and documentation to assess the medical aspects of disability claims.
  • Identify any missing or incomplete information and recommend additional documentation if necessary.
• Work closely with disability adjudicators and case managers to provide clinical insights and support.
• Communicate with healthcare providers to clarify medical information and ensure comprehensive understanding.
• Documentation:
  • Prepare detailed clinical summaries and reports based on the reviewed medical information.
  • Maintain accurate records of all clinical reviews and interactions.
• Communication:
  • Serve as a clinical resource for claims specialists, offering explanations of medical findings and implications.
  • Liaise with internal departments to ensure seamless processing of claims.
  • May require reaching out to attending physician or other medical provider for clarification of conditions and treatment.
• Compliance:
  • Ensure all clinical reviews adhere to company policies, legal standards, and regulatory requirements.
  • Stay updated on relevant medical guidelines and disability insurance regulations.

The base salary range for this position is $60,000 - $80,000. Actual base salaries vary based on skills, experience, and geographical location. In addition to base pay, Equitable provides compensation to reward performance with base salary increases, spot bonuses, and short-term incentive compensation opportunities. Eligibility for these programs depends on level and functional area of responsibility.

For eligible employees, Equitable provides a full range of benefits. This includes medical, dental, vision, a 401(k) plan, and paid time off. For detailed descriptions of these benefits, please reference the link below.

• 5+ years of professional clinical experience
• Hands-on experience in clinical reviews or medical case management
• Experience with group insurance and/or disability claims

Preferred Qualifications

• Bachelor’s degree in nursing or a related field
• Registered Nurse (RN) with a valid nursing license
• Experience and familiarity with behavioral health conditions, treatment and claims, highly desired
• Strong analytical and critical thinking skills
• Excellent written and verbal communication abilities
• Proficiency in medical terminology and understanding of various medical conditions
• Ability to work independently and as part of a multidisciplinary team

Skills

Cross-functional Collaboration: Knowledge of collaborative techniques and approaches; ability to promote a culture of continuous improvement and working together across functions to solve business problems and meet business goals.

Decision Making and Critical Thinking: Knowledge of the decision-making process and associated tools and techniques; ability to accurately analyze situations and reach productive decisions based on informed judgment.

Requirements Analysis: Knowledge of tools, methods, and techniques of requirement analysis; ability to elicit, analyze and record required business functionality and non-functionality requirements to ensure the success of a system or software development project.

Medical Writing/Documentation: Proficiency in medical terminology and understanding of various medical conditions.

ABOUT EQUITABLE
At Equitable, we’re a team committed to helping our clients secure their financial well-being so that they can pursue long and fulfilling lives.
We turn challenges into opportunities by thinking, working, and leading differently – where everyone is a leader. We encourage every employee to leverage their unique talents to become a force for good at Equitable and in their local communities.
We are continuously investing in our people by offering growth, internal mobility, comprehensive compensation and benefits to support overall well-being, flexibility, and a culture of collaboration and teamwork.
We are looking for talented, dedicated, purposeful people who want to make an impact. Join Equitable and pursue a career with purpose.

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Equitable is committed to providing equal employment opportunities to our employees, applicants and candidates based on individual qualifications, without regard to race, color, religion, gender, gender identity and expression, age, national origin, mental or physical disabilities, sexual orientation, veteran status, genetic information or any other class protected by federal, state and local laws.
NOTE: Equitable participates in the E-Verify program.
If reasonable accommodation is needed to participate in the job application or interview process or to perform the essential job functions of this position, please contact Human Resources at [phone] or email us at [e-mail].