Clinical Consultant (RN)

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.

Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. Internal candidates are not required to relocate near an office.

The opportunity:

Sun Life operates with a Work Is Healthy (WisH) approach for disability claims management. As a Clinical Consultant within our Clinical Services team, you will apply your clinical expertise as a member of an interdisciplinary team that focuses on returning clients to optimal levels of productivity. This role does not involve hands-on assessment or direct care. All work is solely performed using electronic medical records and phone/fax communication.

How you will contribute:

• Conduct comprehensive clinical assessments of disability claims that are referred in different venues

• Clarifies medical information and/or interprets medical reports (IMEs/FCEs, hospital and office records, and health care provider's (HCP) calls and letters) and evaluates restrictions and limitations to assess current and ongoing level of impairment

• Synthesizes pertinent facts and answers questions in collaboration with claims professionals

• Meets standards set by management for quality and performance

• Applies current clinical knowledge to medical data regarding diagnosis, treatment, prognosis and impairment

  • Participates proactively through early assessment of medical conditions, functional capacity, and return to work (RTW) opportunities

  • Provides whole person analysis, documenting rationale for opinions and recommended next steps

  • Makes appropriate decisions and takes action as indicated to obtain additional medical information and/or referral to the appropriate resource, such as physician, claims professional, or vocational resource

• Provides input and assistance to identify and collect pertinent medical information through outreach communications with attending physicians, claimants/insureds, and employers

  • Demonstrates excellent verbal and written communication to gather and report information

  • Effectively and accurately educates attending physicians and other health care providers about Sun Life's WisH program

  • Operates with urgency to support claims professionals to determine claim direction and facilitate next steps

  • Outreach to health care provider (HCP), insured, or as indicated to discuss complex medical issues and document outcomes of discussion

• Coordinates with Vocational Rehabilitation Consultant (VRCs) and others in regard to return to work services

  • Evaluates each claim file for RTW opportunities and partners with the VRC to develop RTW plans as indicated

  • Evaluates claims for potential accommodations or partial RTW

  • Partner with VRC to identify functional capabilities for alternative occupations/job duties

• Provides consultation and education to peers and a variety of other business partners

  • Demonstrates knowledge, skill, and problem solving in communicating effectively with both internal customers and with external resources

  • Works collaboratively with clinical and claims professionals to improve disability claim management practices

  • Provides clinical input in claims meetings and leads discussions to facilitate appropriate clinical intervention

  • Provides training and mentoring to new clinical, vocational, claims, and other staff as appropriate. May provide training to groups of peers and/or claims professionals to update their knowledge/skills

What you will bring with you:

• Ability to communicate effectively and professionally with a wide variety of both internal and external Sun Life business partners, peers and resources

• Attention to detail with documentation, reporting and communication

• Facilitation skills in a variety of circumstances and with a wide variety of input. Ability to influence and teach

• Self-directed with an ability to work independently and make independent judgments and decisions

• Strong organizational skills, including the ability to prioritize work and multi-task

• Strong research, analytical, critical thinking, problem solving skills and decision-making skills

• Ability to thrive in a fast-paced, service-oriented environment

• Strong computer skills, proficient in PC environment and MS Word, Excel, and email systems

• A drive to continuously learn, build, and grow professionally

• Insurance claims experience is not a requirement

• RN licensure, active and unrestricted, BSN preferred

• Specialty certification such as CCM, CRRN, or eligible with desire to pursue a plus

• 3+ years of clinical experience working with an adult working age population

• Experience in a rehabilitation setting, Occupational Health, Case/Care Management, Disability Insurance, Group Benefits, or Workers compensation a plus

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We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate. We encourage applications from qualified individuals from all backgrounds.

Life is brighter when you work at Sun Life

At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We're proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S., we've also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row. Visit our website to learn more about our benefits and recognition within our communities.

We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email thebrightside@sunlife.comto request an accommodation.

For applicants residing in California, please read our employee California Privacy Policy and Notice.

We do not require or administer lie detector tests as a condition of employment or continued employment.

Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.