The Clinician will be responsible for the following:
- Assists claims managers in managing claims by reviewing medical information to determine disability status, appropriateness of care, and help develop customized RTW plans.
- Develops action plans for case resolution and for facilitation of appropriate claim decisions including implementation of obtaining additional medical documentation.
- Actively intervenes with claimants and health care providers for initial information, status and clarification.
- Determines the requirements for additional information/documentation including: Medical records, job descriptions, and additional medical authorization if necessary.
- Formulates correspondence and questions for both providers and IMEs and includes appropriate documentation.
- Determines disposition or next steps in continued case management for the Disability Claim Manager.
- College degree in nursing preferred
- Minimum of 2 years hospital experience preferred (Emergency Room Critical Care, Orthopedics, Adult Medical or Surgical or Psychiatric)
- Experience in Disability Case Management, Occupational Health Nursing, or Workers Compensation preferred
- Excellent oral and written communication and critical thinking skills required
- Computer skills including Windows required
A little about us:
Prudential was founded on the belief that being financially prepared is a right, not a privilege.