Description
Our team is committed to driving profitability by delivering exceptional customer service and superb claim outcomes! The ideal candidate will be part of a dynamic and talented team of Behavioral Health Disability Claim professionals that are committed to conducting comprehensive evaluations of disability claimants' functionality via functional assessments. This position is part of a vast team of Behavioral Health Case Managers who are responsible for the review and evaluation of Short-Term Disability (STD) and Long-Term Disability (LTD) claims. While reviewing cases, our goal is to assess a client’s “return to work” potential while also improving their functional capabilities. Successful incumbents in this role will perform functional client assessments and interpret clinical information. They will utilize established clinical guidelines/protocols to facilitate a client’s ability to leverage their functional capabilities, work experience and educational background to allow for a safe and productive return to work environment.
Responsibilities
- Conducts comprehensive evaluation of a disability claimant functionality.
- Advises on highly complex claims at multidisciplinary clinical review roundtables to ensure optimal outcomes.
- Determines when claims contain quality of care issues and escalates these through established channels.
- Independently conferences with treating providers and/or other higher-level facilities to evaluate clinical symptomology present in claimants.
- Leverages resources such as vocational rehabilitation, risk management unit, physician reviews, home assessments, etc.
- Manages risk and resources on highly complex behavioral health claims.
- Identifies appropriate return to work options and/or barriers to partner with internal resources to ensure a smooth transition back into employability and normal activities.
- Reviews clinical integration systems and determines appropriate referral resources to achieve an optimum level of health.
- Supports the leadership team by demonstrating understanding of customer needs and expectations as well as ensuring performance objectives are met.
- Ensures excellent documentation that clearly and concisely communicates focus of functionality vs. impairment and provides a recommendation of support or non-support of clinical findings.
- Collaborates with Ability Benefits Manager and other key players (Vocational Rehabilitation, Consultants, Medical Nurse.
- Reviewers, etc.) for proactive movement of the claim to resolution
- Manages Short Term Disability (STD) to Long Term Disability (LTD) transition on all behavioral health claims, coordinating with all resources necessary to ensure a seamless process.
Qualifications
- Minimum of 3 years of clinical practice experience following a clinical master’s degree.
- Master’s Degree required in a behavioral health or mental health discipline.
- License in Behavioral Health Clinical work which may include professional designations in Social Work, Mental Health, Marriage/Family Counseling, etc.
- Professional licenses in: LMHC, LCSW, LMFT, LPC or other similar designations are required.
- A license to practice independently is required.
- Preference for case management and discharge experience.
- Preference for managed care/utilization review/insurance experience.
- Preference for crisis intervention skills.
- Solid technical acumen with Microsoft Office: Word, Excel & PowerPoint.
- Ability to assess and explain complex medical condition.
- Demonstrated aptitude for communicating with attending physicians to identify current workplace limitations or restrictions.
- Accurate clinical assessment and analytical skills.
- Ability to make sound judgments.
- Readily able to accurately document activities.
- Demonstrated desire to learn about the insurance business.