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We are seeking a knowledgeable and detail-oriented Clinical Nurse Consultant – Long-Term Care to provide clinical expertise and support claims management through comprehensive medical reviews, clinical analysis, and return-to-work and recovery guidance. In this role, you will evaluate medical information related to claims, identify appropriate restrictions and limitations, and provide recommendations that support effective claim outcomes and recovery opportunities.
The ideal candidate combines strong clinical judgment, analytical skills, and a commitment to quality care with the ability to educate claims professionals, collaborate with business partners, and monitor vendor performance.
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WHAT WE CAN OFFER YOU:
- Estimated Salary: Minimum: $74,800 MidPoint: $96,150 Maximum: $117,500, plus annual bonus opportunity, and commission. [Leave bullet at the top; Remove ‘, plus annual bonus opportunity,’ and/or ‘and commission.’ if this does not apply to your role]
- Estimated Salary (Levels have variable responsibilities and qualifications) [multiple levels]: [Leave bullet at the top; Remove ‘, plus annual bonus opportunity,’ and/or ‘and commission.’ if this does not apply to your role]
- Job Title: Minimum: $74,800 MidPoint: $96,150 Maximum: $117,500, plus annual bonus opportunity, and commission
- Job Title: Minimum: $74,800 MidPoint: $96,150 Maximum: $117,500, plus annual bonus opportunity, and commission.
- Base Salary: Minimum: $74,800 MidPoint: $96,150 Maximum: $117,500, plus commission.
- 401(k) plan with a 2% company contribution and 6% company match.
- Work-life balance with vacation, personal time and paid holidays. See our benefits and perks page for details.
- Applicants for this position must not now, nor at any point in the future, require sponsorship for employment. [remove if open to sponsorship]
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WHAT YOU'LL DO:
- Medical Review and Clinical Assessment: Analyze, interpret, and validate medical records and reports; identify restrictions and limitations; determine recovery timelines; recommend next steps; and support appropriate claim decisions and case management strategies.
- Vendor and Resource Management: Coordinate and monitor disability case management and long-term care assessment services, evaluate quality and outcomes, identify cost savings, and maintain a nationwide database of available services and resources.
- Communication and Collaboration: Partner with claimants, families, physicians, medical facilities, attorneys, insurers, employers, and other stakeholders to obtain and clarify medical information, explain policy benefits, develop care plans, and address complex medical conditions.
- Clinical Consultation and Risk Management: Recommend external medical consultations, evaluate alternative care options, advise on appropriate medical handling, support legal proceedings, and inform management about service quality, resource effectiveness, and risk mitigation.
- Education and Continuous Improvement: Develop and deliver clinical training for claims associates, stay current on industry trends and best practices, participate in professional seminars, and develop innovative care programs to improve outcomes, add value, and control costs.
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WHAT YOU’LL BRING:
- Education and Licensure: Licensed Registered Nurse (RN) with knowledge or experience in disability case management, elder care, long-term care, critical illness, early intervention, treatment mechanisms, claims procedures, or related areas. Bachelor of Science degree preferred; an associate degree with relevant credentials or experience will be considered.
- Clinical and Analytical Expertise: Demonstrates sound judgment, initiative, creativity, critical thinking, strong analytical and problem-solving skills, and confident decision-making abilities.
- Communication and Collaboration: Possesses excellent written and verbal communication, interpersonal, facilitation, and organizational skills, with the ability to work effectively in a fast-paced, team-oriented corporate environment.
- Adaptability and Workload Management: Works independently, manages multiple cases and deadlines, navigates multiple business systems, adapts to changing priorities, learns new insurance products and procedures, and is willing to travel up to 25% of the time.
- Customer Focus and Regulatory Compliance: Prioritizes customer needs while ensuring high-quality, timely, and compliant claim decisions, with knowledge of insurance policy language, provisions, and applicable regulations, including ERISA.
- You promote a collaborative culture, value different ideas and opinions, and listen courageously, remaining curious in all that you do.
- Able to work remotely with access to a high-speed internet connection and located in the United States.
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PREFERRED:
- Bachelor's Science Nursing (BSN) is preferred
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We value unique experience, skills, and passion for innovation. If your experience aligns with the listed requirements, please apply!
If you have questions about your application or the hiring process, email our Talent Acquisition area at careers@mutualofomaha.com. Please allow at least one week from time of applying if you are checking on the status.
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