Licensed Clinical Specialist
Job Summary
To enhance customer service and case management for long-term care insurance policyholders, the full-time remote Claims Clinical Specialist will utilize clinical expertise to conduct telephonic assessments, manage claims processes, and collaborate with medical personnel while promoting evidence-based care.
Key responsibilities
- Conduct telephonic assessments and develop plans of care in collaboration with medical personnel
- Analyze medical records to understand disease progression and determine care needs and benefit eligibility
- Identify process improvement opportunities and provide feedback to enhance team performance and results
Required qualifications
- Active Licensed Social Worker or Registered Nurse
- Minimum of two years of experience with understanding medical conditions affecting the aging population
- Ability to interpret MDS, Plan of Care, and medical records related to disease progression
- Experience in making business decisions using risk management and quality protocols
- Familiarity with systems applications such as WORD, EXCEL, and PowerPoint
Complete Job Description
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