[Hiring] Behavioral Health Consultant @Sun Life

Role Description

As a Behavioral Health 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:

• The BHC plays a key role to clarify functional capacity, treatment plan, and overall prognosis for return to work (RTW) through early interventions.
• Conducts comprehensive behavioral health clinical assessments of disability claims that are referred in different venues.
• Clarifies medical information and/or interprets medical reports 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 volume of work performed.
• Applies current clinical knowledge to medical data regarding diagnosis, treatment, prognosis, and impairment.
• Participates proactively through early assessment of medical issues, functional capacity, and RTW opportunities.
• Determines what medical information is needed to evaluate function on an ongoing basis.
• Conducts analysis of medical information, including current treatment plan, provider opinion, and documents 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.
• Provides input and assistance to identify and collect pertinent medical information through outreach communications.
• Demonstrates excellent verbal and written communication to gather and report information, clarify restrictions and limitations, and assist with return to work.
• Operates with urgency to support assigned claims professionals in effective and appropriate claim direction.
• Coordinates with Vocational Rehabilitation Consultant (VRCs), nurses, and others regarding return-to-work services.
• Evaluates each claim file for RTW opportunities and partners with the VRC to develop RTW plans as indicated.
• Provides consultation and education to peers and a variety of other constituents.
• 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.

Qualifications

• LICSW active and unrestricted licensure, MSW preferred; candidates with relevant experience may be considered.
• RN active and unrestricted licensure, BSN preferred; candidates with relevant experience may be considered.
• Specialty certification such as C-ASWCM, ASAM, CCM, CRRN, Psychiatric Mental Health Nursing, Forensic Nurse, LCPC/LPC or eligible with desire to pursue a plus.
• Minimum of 3 years clinical experience working with an adult working age population.
• Experience in a rehabilitation setting, psychiatric setting, Occupational Health, Case/Care Management, Disability Insurance, Group Benefits, or Workers compensation a plus.
• Ability to communicate effectively and professionally with a wide variety of both internal and external business partners.
• Attention to detail with documentation, reporting, and communication.
• Facilitation skills in a variety of circumstances and with a wide variety of input.
• 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 and desire to work 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.

Requirements

• Insurance claims experience is not a requirement.

Benefits

• 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.
• Partially paid sabbatical program.
• 401(k) employer match, stock purchase options, and an employer-funded retirement account.
• Flexible, inclusive, and collaborative work environment that supports career growth.