Nurse Consultant
Core
Provide medical expertise to investigate, evaluate, and resolve injury claims (workers' comp, PIP, liability) and develop clinical programs.
Role type
Senior clinical nurse consultant (case management)
Builds
Clinical programs and procedures for insurance claims resolution
Domain
Insurance / Healthcare
Required skills
Clinical nursing expertise, medical record evaluation, claims investigation, vendor negotiation, training delivery, program development
Preferred skills
Orthopedics/neurology/rehab/trauma background, case management experience, CCM/CIRS/CDMS/CRRN/COHN certification, BSN degree
Technologies
Microsoft Office, WebEx, telephonic presentation tools
Responsibilities
Collaborate with claims associates on injury claim resolution, evaluate medical records for treatment appropriateness, negotiate rates with healthcare providers, develop and implement clinical programs, deliver trainings to claims staff
Seniority
Mid-to-Senior level (3-5 years experience required)