Sr. Consultant, Nurse Long Term Care

Alternate Locations: Work from Home (Excluding Colorado)

Work Arrangement:Work from Home

Relocation assistanceis not available for this opportunity.

Level:P4

Requisition #:66802

About The Company

Lincoln Financial Group, a Fortune 250 company with over 10,000 employees, provides advice and solutions that help empower Americans to take charge of their financial lives with confidence. Our core business areas - Life Insurance, Annuities, Retirement Plan Services and Group Protection - focus on supporting, preserving and enhancing over 17 million customer's lifestyles and retirement outcomes.

Headquartered in Radnor, Pennsylvania, Lincoln Financial Group is the marketing name for Lincoln National Corporation (NYSE: LNC) and its affiliates. The company had $238 billion in assets under management as of December 31, 2018.

Ranked one of the Best Large Employers in America by Forbes magazine, Lincoln Financial Group makes a serious investment in our employees' futures through a broad range of wealth accumulation and protection plans, health and wellness programs, and career development resources designed to help each individual reach their personal and professional goals.

Be Aware of Fraudulent Recruiting Activities

If you are interested in a career at Lincoln, we encourage you to review our current openings and apply on our website. Lincoln values the privacy and security of every applicant and urges all applicants to diligently protect their sensitive personal information from scams targeting job seekers. These scams can take many forms including fake employment applications, bogus interviews and falsified offer letters.

Lincoln will not ask applicants to provide their social security numbers, date of birth, bank account information or other sensitive information in job applications. Additionally, our recruiters do not communicate with applicants through free e-mail accounts (Gmail, Yahoo, Hotmail) or conduct interviews utilizing video chat rooms. We will never ask applicants to provide payment during the hiring process or extend an offer without conducting a phone, live video or in-person interview.Please contact Lincoln's fraud team atfraudhotline@lfg.com if you encounter a recruiter or see a job opportunity that seems suspicious.

General Purpose of Job

This position will provide subject matter expertise and direction on the analysis and interpretation of complex claim/medical information for LTC claims. They will direct the coordination of external clinical vendor services, evaluate the level of functional and/or cognitive impairment of claimants, review potential denials, appeals and complaints and estimate duration of recovery.

Duties and Responsibilities

Monitors product/claims/LTC regulations and ensures compliance and continuous improvement of the claims compliance process.

Analyzes complex reports & data and identifies trends and resources that improve delivery of clinical review services.

Assists with product development to align claims practices with policy language to improve efficiency, mitigate risk, increase cost savings & provide a positive customer experience

Provides direction on complex assignments, projects, and/or initiatives to build and enhance the capability of their assigned area(s) of responsibility.

Provides medical insight to improve claims processes and creates effective and consistent practices.

Directs and enhances organizational initiatives by positively influencing and supporting change management and/or departmental/enterprise initiatives within assigned area(s) of responsibility.

Provides subject matter expertise to team members and applicable internal/external stakeholders on complex assignments/projects for their assigned area(s) of responsibility.

Directs the coordination of external clinical vendor services (peer reviews, BEAs, IMEs) as needed. Supports quality assurance audits of external vendors.

Identifies and directs the implementation of process improvements that significantly improve quality across the team, department and/or business unit for their assigned area(s) of responsibility.

Reviews appealed claims and develops procedures and training to decrease appealed cases and overturned decisions.

Increases fraud identification and referral opportunities in the claims area to decrease payment of ineligible claims and limit open claim reserves.

Reviews complex claim decisions.

Leads claim review and appeal committees.

Reviews quality audit results and develops training and process improvements.

Maintains knowledge on current and emerging developments/trends for assigned area(s) of responsibility, assesses the impact, and collaborates with senior management to incorporate new trends and developments in current and future solutions.

Serves as a subject matter expert for clinical & process consultation.

Additional Position Responsibilities

Performs other duties as required.

Carries out duties in compliance with all state and federal regulations and guidelines. Complies with all company and site policies and procedures.

Remains current in profession and industry trends.

Makes a positive contribution as demonstrated by: - Making suggestions for improvement - Learning new skills, procedures and processes

Other Skills and Abilities

Education

4 Year/Bachelor's degree or equivalent work experience (4 years of experience in lieu of Bachelor's) - Minimum Required

Certifications

Current Registered Nurse license -Upon Hire

Experience

5 7+ Years in Nursing directly aligned to the specific responsibilities for this position. (Required )

Work Arrangement:

Work from Home:Employees will work fully from home. Their job will not require the employee to come into the office, unless for special circumstances.

This position may be subject to Lincoln's Political Contribution Policy. An offer of employment may be contingent upon disclosing to Lincoln the details of certain political contributions. Lincoln may decline to extend an offer or terminate employment for this role if it determines political contributions made could have an adverse impact on Lincoln's current or future business interests, misrepresentations were made, or for failure to fully disclose applicable political contributions and or fundraising activities.

Any unsolicited resumes/candidate profiles submitted through our web site or to personal e-mail accounts of employees of Lincoln Financial Group are considered property of Lincoln Financial Group and are not subject to payment of agency fees.

Lincoln Financial Group ("LFG") is an Equal Opportunity employer and, as such, is committed in policy and practice to recruit, hire, compensate, train and promote, in all job classifications, without regard to race, color, religion, sex (including pregnancy), age, national origin, disability, sexual orientation, gender identity and expression, veterans status, or genetic information. Applicants are evaluated on the basis of job qualifications. If you are a person with a disability that impedes your ability to express your interest for a position through our online application process, or require TTY/TDD assistance, contact us by calling 260-455-2558.

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