RN Clinical Consultant

Guardian Life Insurance; United States; Remote; USD 69,000 - 113,000; Full time

Job summary

Guardian Life Insurance is seeking an RN Clinical Consultant to serve as a clinical expert supporting short-term and long-term disability claim evaluations. You will analyze medical information, assess functional capacity, and provide guidance to support claim decisions while collaborating with providers and claims professionals.

You will review documentation, estimate recovery timelines, and educate staff on medical implications, ensuring timely, high-quality outcomes for claimants across the

Qualifications

• Active RN license
• 5+ years direct acute patient care
• 3+ years as clinical consultant in LTD/STD (LTD preferred)
• Knowledge of medical conditions and disability duration
• Excellent verbal and written communication
• Clinical assessment and analytical skills
• Independent judgment for clinical decisions
• MS Office proficiency

Responsibilities

• Review short-term and long-term disability claims to evaluate medical documentation, functional limitations, and recovery timelines.
• Analyze impact of illness, injury, and treatment plans on daily living activities and work capacity.
• Collaborate with treating providers, claimants, case managers, and vocational specialists to promote appropriate treatment and return-to-work.
• Educate claims professionals on medical conditions and disability-related outcomes as a clinical SME.
• Coordinate independent medical reviews and ensure timely resolution of complex questions.
• Manage high-volume workload while prioritizing customer needs and quality improvements.
• Mentor and train staff on medical and functional impact on claims.

Skills

Clinical assessment

Analytical thinking

Verbal & written communication

Time management

Independent judgment

Microsoft Office

Education

BSN (preferred)

CCM designation (preferred)

Tools

DCMS

Claim Facts

iProcess

Job description

Are you a registered nurse who is passionate about helping individuals achieve optimal recovery and return-to-work outcomes? Guardian is seeking an RN Clinical Consultant to serve as a clinical expert supporting the evaluation of short-term and long-term disability claims. In this role, you will analyze medical information, assess functional capacity, collaborate with healthcare providers, and provide clinical guidance that supports claim decisions. You will play a critical role in enhancing customer outcomes through sound clinical judgment, proactive case collaboration, and a commitment to exceptional service.

You are

A highly motivated and clinically skilled registered nurse who thrives in a fast-paced, customer-focused environment. You can work independently while also collaborating effectively with claim professionals, healthcare providers, vocational specialists, and internal business partners. You are analytical, detail-oriented, and decisive, with the ability to evaluate complex medical information and translate clinical findings into actionable recommendations. You act with urgency and accountability while maintaining a strong commitment to improving claimant outcomes and customer experiences.

You have

Required Qualifications:

• 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

Preferred Qualifications:

• 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

You will

• 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.

Reporting Relationships

• As our RN Clinical Consultant , you will report to our Clinical Team Leader , who reports to our Director, Clinical Services.

Location

• Plano, TX, Bethlehem, PA, Holmdel, NJ,or fully remote

Travel

• Occasional 0-10% of the time.

Salary Range:

$68,970.00 - $113,310.00

The salary range reflected above is a good faith estimate of base pay for the primary location of the position. The salary for this position ultimately will be determined based on the education, experience, knowledge, and abilities of the successful candidate. In addition to salary, this role may also be eligible for annual, sales, or other incentive compensation.

Our Promise

At Guardian, you’ll have the support and flexibility to achieve your professional and personal goals. Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.

Inspire Well-Being

As part of Guardian’s Purpose – to inspire well-being – we are committed to offering contemporary, supportive, flexible, and inclusive benefits and resources to our colleagues. Explore our company benefits at www.guardianlife.com/careers/corporate/benefits. Benefits apply to full-time eligible employees. Interns are not eligible for most Company benefits.

Equal Employment Opportunity

Guardian is an equal opportunity employer. All qualified applicants will be considered for employment without regard to age, race, color, creed, religion, sex, affectional or sexual orientation, national origin, ancestry, marital status, disability, military or veteran status, or any other classification protected by applicable law.

Accommodations

Guardian is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.Guardian also provides reasonable accommodations to qualified job applicants (and employees) to accommodate the individual’s known limitations related to pregnancy, childbirth, or related medical conditions, unless doing so would create an undue hardship. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact [e-mail]. Please note: this resource is for accommodation requests only. For all other inquires related to your application and careers at Guardian, refer to the Guardian Careers site.

Visa Sponsorship

Guardian Life is not currently or in the foreseeable future sponsoring employment-based visas (e.g., such as an H-1B). In order to be a successful applicant, you must be legally authorized to work in the United States, without the need for employer sponsorship/support now or at any time in the future.

Notice Regarding Guardian’s Use of Artificial Intelligence in Recruitment

As part of Guardian’s job application process, Guardian may use artificial intelligence tools (“AI Tools”) to automate the sorting and filtering of information provided by applicants as part of its preliminary screening. This preliminary screening may be used to help identify applicant materials and resumes relative to their indication that the applicant meets the requirements for the specific job for which they are applying, as specified in the listing posted on Guardian’s jobs website (Careers at Guardian at https://www.guardianlife.com/careers). At Guardian, we do not use AI Tools to substantially assist or replace human judgment or discretionary decision making in our hiring process. All hiring decisions will be made by Guardian colleagues.

Please be aware that if you apply for a specific position with Guardian, you will have the choice of opting out of Guardian’s use of AI Tools during the job application process. If you would like to request an alternative process that does not utilize AI Tools or would like to request a reasonable accommodation, within ten business days of your position application, you must email your request to [e-mail], making sure to provide your name and job requisition identification number. Guardian will retain your applicant materials and resume and all information therefrom in accordance with Guardian’s document retention policy, a copy of which you may request via [e-mail].

Additionally, at applicable times, Guardian will make public the most recent bias audit results for such AI tools, which may be found here.

Current Guardian Colleagues: Please apply through the internal Jobs Hub in Workday.