Licensed Clinical Specialist

To enhance customer service and case management for long-term care insurance policyholders, the full-time remote Claims Clinical Specialist will utilize clinical expertise to conduct telephonic assessments, manage claims processes, and collaborate with medical personnel while promoting evidence-based care. Key responsibilities Conduct telephonic assessments and develop plans of care in collaboration with medical personnel Analyze medical records to understand disease progression and determine care needs and benefit eligibility Identify process improvement opportunities and provide feedback to enhance team performance and results Required qualifications Active Licensed Social Worker or Registered Nurse Minimum of two years of experience with understanding medical conditions affecting the aging population Ability to interpret MDS, Plan of Care, and medical records related to disease progression Experience in making business decisions using risk management and quality protocols Familiarity with systems applications such as WORD, EXCEL, and PowerPoint