Clinical Advocate (Finance)

The Clinical Advocate provides medical and vocational assistance to claimants that are unable to work, or have physical or psychological impairments that limit their ability to perform essential job duties. The Clinical Advocate will review medical documentation, and work closely with the claim team and internal clinical resources in making recommendations that address functionality and focus on a healthy return to work. The Clinical Advocate will have contact with the claimant and employer in facilitating any temporary or permanent job modifications necessary for a return to work within the applicable restrictions given by the treating provider as needed. The Clinical Advocate will support the claimant's participation in various programs, activities and services designed to help them with a return to previous levels of functioning.

• Bachelor's degree in a health-related field is required. Bachelor's degree in Nursing preferred.
• For Vocational Clinical Advocates, a master's degree in vocational counseling, or rehabilitation counseling is preferred.
• For a Nursing Clinical Advocates, a valid RN license is required. Individuals must hold an active, registered nurse professional license without restrictions to practice as a health professional in a state or territory of the United States.
• Minimum 3-4 years full time clinical experience as it relates to leave and disability claims administration.
• Demonstrated ability to handle complex assignments and ability to work independently is required.
• Effective oral and written communication skills are required.
• Thorough understanding of leave and disability matters and advanced knowledge about workplace restrictions and modifications.
• Ability to exert positive influence in all areas of RTW negotiation and coordination
• Advanced communications and interpersonal skills in order to conduct training, provide mentorship, and assist supervisor in general areas as assigned.
• Highly skilled at promoting leave and disability products and services internally and externally.
• Limited travel may be needed

• Reviews claim documentation and reports, collects and analyzes medical data, assesses client's leave and disability status
• Evaluates claimant's functionality based on medical information received and reviews job description when considering return to work plans
• Demonstrates ability to meet or surpass administrative requirements, including productivity, time management, quality assessment (QA) standards with a minimum of supervisory intervention
• Establishes a professional working relationship with the claimant, treating provider, client representatives and the claim team members. Coordinates return to work plans with the claim team and parties above
• May recommend and facilitate additional services, peer reviews, IME's, ergonomic and vocational assessments as needed
• Provides analysis of restrictions and limitations submitted and makes recommendations to facilitate rehabilitation goals and RTW. Strong focus given to modified RTW to help transition claimant back to full duty
• Maintains contact and communicates with claims teams to apprise them of case activity, or to receive authorization for additional services
• Reviews cases with immediate supervisor and claim team monthly to evaluate file and obtain direction
• Responsible for documentation in claims system with focus on clinical assessment, RTW goals, scheduling follow up contacts, and providing guidance to the claim team
• Limited travel may be needed
• May perform other related duties as assigned
• Upholds the Crawford Code of Conduct