Medical Reviewer - CT08BE

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The PPD Clinical Consultant is accountable for the achievement of Claim Center goals specific to Permanent Partial Disability payments.  In collaboration with the Claim Handler the PPD Clinical Consultant will apply his/her medical expertise to review impairment ratings utilizing AMA and state-specific software supported guidelines.  The PPD Clinical Consultant will provide PPD-specific clinical support to the Claim Handler, collaborating to develop an appropriate fair PPD strategy to assist with settlement.

• Review and interpret all treating physician impairment ratings and supportive medical records to determine impairment in accordance with the appropriate state guidelines

• Apply findings into a comparative report used to clarify with treating physician rating results, and to support PPD recommendations, negotiations and outcomes measures

• Provide clinical outcomes reports and expertise to NCM and Claim Handler to support PPD strategy

• Utilize clinical knowledge and appropriate written and verbal skills to clearly communicate with treating providers via the Claim Handler

• Participate in medical quality audits and reports (is this like the LOR/HQR)

• Collaborate with Claim Handler to combine skills and experience to develop comprehensive PPD and assist with claim settlement strategies as needed

Qualifications:

• Registered Nurse, Occupational Therapist, Physical Therapist or other related healthcare professional with a minimum of 3 years clinical practice, preferably in rehabilitation, orthopedics, neuro/neuro- surgery or occupational health

• Professional certification is a plus (such as CCM, CRRN, CIRS, etc.) or Bachelors’ degree in a health-related field

• Experience with workers’ compensation rules and regulations preferred

• Understanding of PPD rules and requirements, claim management, case management, and/or utilization review methodology preferred

• Excellent verbal and written communication skills

• Strong organizational and prioritization skills

• Computer proficiency

Additional Information:

• This role can have a Hybrid or Remote work arrangement. Candidates who live near one of our office locations (Hartford, CT, San Antonio, TX, Lake Mary, FL, Phoenix, AZ, Naperville, IL) will have the expectation of working in an office 3 days a week (Tuesday through Thursday).   Candidates who do not live near an office will have a remote work arrangement, with the expectation of coming into an office as business needs arise.

Compensation

The listed annualized base pay range is primarily based on analysis of similar positions in the external market. Actual base pay could vary and may be above or below the listed range based on factors including but not limited to performance, proficiency and demonstration of competencies required for the role. The base pay is just one component of The Hartford’s total compensation package for employees. Other rewards may include short-term or annual bonuses, long-term incentives, and on-the-spot recognition. The annualized base pay range for this role is:

$66,000 - $99,000

Equal Opportunity Employer/Sex/Race/Color/Veterans/Disability/Sexual Orientation/Gender Identity or Expression/Religion/Age

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