[Hiring] Nurse Case Manager @Alight Solutions

Role Description

The Nurse Consultant functions as a member of our Clinical Center of Excellence and serves as a clinical consult nurse to our non-clinical disability claim examiners. This role provides clinical expertise and guidance to claim examiners as they manage short- and long-term disability claims. Using MD Guidelines, the Nurse Consultant facilitates medically sound decisions and case navigation strategies, ensuring disability claims are adjudicated appropriately and employees return to work within medically reasonable time frames.

• Serve as primary clinical resource on a team of claim examiners managing medical disability and accommodation cases.
• Provide consultation, feedback, and charting to assist claim examiners on understanding functional impairment related to employees’ jobs with an emphasis on returning medically able individuals back to work.
• Consult on medical claims within their scope of licensure and clinical expertise.
• Ability to clearly communicate claim decisions and contract language verbally and in written correspondence.
• Excellent analytical, problem solving, and communication skills (verbal & written) essential.

Qualifications

• Registered Nurse, Nurse Practitioner, or comparable license with experience, with working knowledge of disability, client processes, and case management.
• Minimum of 3 years clinical experience, preferably in the occupational health field.
• Preferred experience in disability claims management or Workers Compensation claim management.
• Dedicated to providing high quality customer service, using diplomacy, patient advocacy, and professional competency.
• Must show evidence of appropriate degree.
• Work experience of 4 years +.
• Ability to work evening/night shifts.
• Regulatory and Compliance experience a plus.

Benefits

• Programs and plans for a healthy mind, body, wallet, and life.
• Variety of health coverage options.
• Wellbeing and support programs.
• Retirement plans.
• Vacation and sick leave.
• Maternity, paternity & adoption leave.
• Continuing education and training.
• Several voluntary benefit options.