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41524 Clinical Care Consultant - Bilingual English SpanishSalary OPEN – WILL RELOCATE REQUIRED: 1. Licensed RN. 2. Bilingual English Spanish. 3. Strong Long Term Disability experience with variety of impairment knowledge. 4. Senior Clinical Care Managers must possess one or more related certifications such as Certified Rehabilitation Registered Nurse, Certified Case Manager, etc. 5. They would prefer to have someone that currently works on disability business if we can find that experienced. Company has an excellent opportunity for a clinical professional. This position requires the incumbent to be fluent in Spanish and English. Dimensions/Scope of Position: Accounts and authority levels are defined by Claims Manager and are directly related to training and experience. Duties include medical assessment of claims as well as ongoing case management when appropriate. Essential Duties/Responsibilities: 1) Conduct comprehensive clinical assessments of short and long term disability claims that are referred and provide feedback as to how medical findings relate to functionality. Obtain information by phone contact to physician, employee, employer or others. Provide guidance to other staff in obtaining such. 2) Assist with determining eligibility for benefits by assessing pre-existing issues. 3) Provide ongoing clinical case management with three-point contact to employee, employer and physician when appropriate to facilitate optimum claim resolutions. 4) Act as a Team Resource and participate by answering questions regarding medical issues and functionality and provide clear and complete clinical recommendations for short and long-term goals at team meetings. 5) Manage IME and Peer to Peer referrals and analysis of results by reviewing appropriateness and timeliness of evaluation. Provide interpretation and documentation of results when completed. 6) Using network resources, direct vendor services and activities on referrals by outlining and communicating specific service requests and ensuring service quality and correlated expenses. 7) Provide or coordinate in service training to claim and rehabilitation staff to enhance staff knowledge. Provide information to staff on what clinical resources are available. 8) Provide sales/service support internally and to employers and client companies through questionnaires, presentations and reports. 9) Keep abreast of current medical technology and utilize such when able. 10) Document claim files and systems in the approved format and in a clear, consistent and professional manner. 11) Identify cases with potential for changes in outcome plan. 12) Maintain a level of participation and commitment to individual, team, client companies, and company results. Note any trends that may be effecting liability and advise appropriate parties of such. Keep abreast of policy provisions and language on accounts serviced. Contribute to and support company's approach to disability management by assessing, clarifying and developing medical issues to assist in determining eligibility and assessing functionality for individuals applying for and receiving disability benefits ensuring effective optimum outcomes and quality customer service. Job Requirements Job related requirements include a proficiency in oral and written communication. Must be fluent in Spanish and English with the ability read, write and speak both languages. Assessments, problem solving, plan development and implementation skills are essential. Incumbent must possess sufficient knowledge and understanding of CPT and ICD-9 coding as care managers may be responsible for correctly coding to reflect the medical information within various claim systems on cases referred.