Are you a registered nurse who is passionate about helping individuals achieve optimal recovery and return-to-work outcomes? Guardian is seeking an
RN Clinical Consultant to serve as a clinical expert supporting the evaluation of short-term and long-term disability claims. In this role, you will analyze medical information, assess functional capacity, collaborate with healthcare providers, and provide clinical guidance that supports claim decisions. You will play a critical role in enhancing customer outcomes through sound clinical judgment, proactive case collaboration, and a commitment to exceptional service.
You areA highly motivated and clinically skilled registered nurse who thrives in a fast-paced, customer-focused environment. You can work independently while also collaborating effectively with claim professionals, healthcare providers, vocational specialists, and internal business partners. You are analytical, detail-oriented, and decisive, with the ability to evaluate complex medical information and translate clinical findings into actionable recommendations. You act with urgency and accountability while maintaining a strong commitment to improving claimant outcomes and customer experiences.
You haveRequired Qualifications:- Active Registered Nurse (RN) license
- Minimum of 5 years of direct acute patient care experience
- Minimum of 3 years' experience as a clinical consultant in LTD and/or STD (LTD preferred)
- Strong knowledge of medical conditions, treatments, and their impact on functional capacity and disability duration
- Excellent verbal and written communication skills
- Strong clinical assessment, analytical, critical thinking, and research skills
- Ability to exercise independent judgment and make sound clinical decisions
- Strong organizational and time-management skills with the ability to prioritize competing demands
- Proficiency with Microsoft Office applications, including Word, Excel, and PowerPoint
- Ability to adapt to changing business needs and work effectively in a dynamic environment
Preferred Qualifications:- Bachelor of Science in Nursing (BSN)
- Certified Case Manager (CCM) designation
- Experience supporting disability, absence management, or insurance-based claims operations
- Knowledge of disability products, business rules, and claims procedures
- Experience with DCMS, Claim Facts, iProcess, or similar claims management systems
You will- Review short-term and long-term disability claims to evaluate medical documentation, functional limitations, treatment progress, and expected recovery timelines.
- Analyze the impact of illness, injury, and treatment plans on a claimant's ability to perform occupational and daily living activities, providing clinical recommendations that support claim decisions.
- Collaborate with treating providers, claimants, case managers, and vocational rehabilitation specialists to promote appropriate treatment plans, clarify medical information, and facilitate return-to-work opportunities.
- Serve as a clinical subject matter expert by educating claims professionals on medical conditions, treatment interventions, functional impairments, and disability-related outcomes.
- Coordinate independent medical reviews and assessments, ensuring quality, accuracy, and timely resolution of complex clinical questions.
- Manage a high-volume workload while prioritizing customer needs, resolving issues proactively, and supporting continuous quality improvement initiatives.
- Provide ongoing mentoring and training to claims staff and peers regarding the medical and functional impact of injury, illness, and treatment on disability claims.
Reporting Relationships- As our RN Clinical Consultant, you will report to our Clinical Team Leader, who reports to our Director, Clinical Services.
Location - Plano, TX, Bethlehem, PA, Holmdel, NJ, or fully remote
Travel- Occasional 0-10% of the time.
Salary Range:$68,970.00 - $113,310.00
The salary range reflected above is a good faith estimate of base pay for the primary location of the position. The salary for this position ultimately will be determined based on the education, experience, knowledge, and abilities of the successful candidate. In addition to salary, this role may also be eligible for annual, sales, or other incentive compensation.
