RN, LOA Clinical Consultant-19574

WellPoint is the nation's leading health benefits company serving the needs of approximately 28 million medical members nationwide.



The LOA Clinical Consultant provides medical consultation to LOA case managers. Reviews complex disability and FMLA/ADA claims for appropriate disposition. Performs review of LOA cases for consistency in decisions by LOA staff related to medical diagnoses. Provides medical in-service education and training sessions to LOA staff (medical related, disability, continuing education). Provides the face of LOA (medical liaison) to the medical provider community. Performs critical audits of disability claims for medical documentation, and is a link in decision making. Ambassadors the transition to work programs into the company - based on clinical data and influence. Serves as the point of contact for second opinions, IME's (independent medical evaluations) of disability claims, and for the disability appeals process. Educates HR, managers and associates of clinical data linked to LOA data with the goal of reducing associate absences.

Qualified candidates will have an active, unrestricted Indiana RN license, and at least 3 years of acute care experience in a medical-surgical setting or recent disability claims experience or equivalent related experience. Strong written, oral and interpersonal communication skills required. Ability to comprehend medical policy and criteria to clearly articulate health information required. Strong analytical and problem-solving skills required. Strong computer skills required.