Licensed Clinical Specialist

Job Summary

To support a growing medical review team, the full-time remote Claims Clinical Specialist will leverage clinical expertise to conduct telephonic assessments, manage care plans, and enhance in-house certification processes for long-term care insurance policyholders.

Key responsibilities

• Conduct telephonic assessments and communicate with medical personnel to develop care plans and provide necessary certifications
• Analyze medical records to understand disease progression and care needs of insured individuals
• Identify process improvement opportunities and collaborate with team members to enhance performance and results

Required qualifications

• Active Licensed Social Worker or Registered Nurse
• At least two years of experience in a role requiring knowledge of medical conditions affecting the aging process
• Ability to interpret MDS, Plan of Care, and various medical records
• Experience in making business decisions using risk management and quality protocols
• Familiarity with insurance contracts and Long-Term Care benefits