Description
Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.
Job Description:
Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. Our team members and leaders are expected to foster connection and teamwork by being present in the office at least 2 days per week.
The Opportunity
As a Behavioral Health Consultant within our Clinical Services team, you will apply your clinical expertise as a member of an interdisciplinary team that focuses on returning clients to optimal levels of productivity. This role does not involve hands-on assessment or direct care. All work is solely performed using electronic medical records and phone/fax communication.
How you will contribute:
The BHC plays a key role within that context to clarify functional capacity, treatment plan, and overall prognosis for return to work (RTW) through early interventions, such as provider contact, and other action planning with claims and vocational partners.
As a BHC within our Clinical Services team, you will experience the benefit of a flexible work environment. Our focus is the quality of your work, not the quantity of the hours you spend in the office. We understand that life exists outside of work, and we want you to love your job and have the balance you need to enjoy your life outside of work.
Conducts comprehensive behavioral health clinical assessments of disability claims that are referred in different venues:
Clarifies medical information and/or interprets medical reports (IMEs, hospital and office records, and health care provider's (HCP) calls and letters) and evaluates restrictions and limitations to assess current and ongoing level of impairment.
Synthesizes pertinent facts and answers questions in collaboration with claims professionals
Meets standards set by management for quality and volume of work performed
Applies current clinical knowledge to medical data regarding diagnosis, treatment, prognosis, and impairment:
Participates proactively through early assessment of medical issues, functional capacity, and RTW opportunities
Determines what medical information is needed to evaluate function on an ongoing basis. Conducts analysis of medical information, including current treatment plan, provider opinion and either verbally or in writing documents rational for opinions and recommended next steps.
Makes appropriate decisions and takes action as indicated to obtain additional medical information and/or referral to the appropriate resource, such as physician, claims professional, clinical or vocational resource
Provides input and assistance to identify and collect pertinent medical information through outreach communications with attending physicians/health care providers, claimants/insureds, and employers:
Demonstrates excellent verbal and written communication to gather and report information, clarify restrictions and limitations, and assist with return to work
Operates with urgency to support assigned claims professionals in effective and appropriate claim direction to identify and facilitate next steps and follow up needs on each individual claim file
Makes contacts to insured, employer, and the HCP (health care provider) as indicated to understand symptoms, treatment, and impact on functional capacity.
Coordinates with Vocational Rehabilitation Consultant (VRCs), nurses and others in regard to return-to-work services:
Evaluates each claim file for RTW opportunities and partners with the VRC to develop RTW plans as indicated
Evaluates claims for potential accommodations or partial RTW
Working with the VRC to identify functional capabilities for alternative occupations/job duties
Provides consultation and education to peers and a variety of other constituents:
Demonstrates knowledge, skill, and problem solving in communicating effectively with both internal customers and with external resources
Works collaboratively with clinical and claims professionals to improve disability claim management practices
Provides clinical input in claims meetings and leads discussions to facilitate appropriate clinical intervention
Provides training and mentoring to new clinical, vocational, claims, and other staff as appropriate. May provide training to groups of peers and/or claims professionals to update their knowledge/skills
What you will bring with you:
LICSW active and unrestricted licensure, MSW preferred however, candidates with relevant experience may be considered or RN active and unrestricted licensure, BSN preferred; however, candidates with relevant experience may be considered
Specialty certification such as C-ASWCM (Certified Advanced Social Work Case Manager), ASAM, CCM, CRRN, Psychiatric Mental Health Nursing, Forensic Nurse, LCPC/LPC or eligible with desire to pursue a plus
Minimum of 3 years clinical experience working with an adult working age population
Experience in a rehabilitation setting, psychiatric setting, Occupational Health, Case/Care Management, Disability Insurance, Group Benefits, or Workers compensation a plus
Ability to communicate effectively and professionally with a wide variety of both internal and external Sun Life business partners, peers and resources.
Attention to detail with documentation, reporting and communication.
Facilitation skills in a variety of circumstances and with a wide variety of input. Ability to influence and teach.
Self-directed with an ability to work independently and make independent judgments and decisions.
Strong organizational skills, including the ability to prioritize work and multi-task.
Strong research, analytical, critical thinking, problem solving skills and decision-making skills
Ability and desire to work in a fast-paced, service-oriented environment
Strong computer skills, proficient in PC environment and MS Word, Excel, and email systems
A drive to continuously learn, build, and grow professionally
Insurance claims experience is not a requirement
Salary Range: $78,600 - $117,900
At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.
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We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate. We encourage applications from qualified individuals from all backgrounds.
Life is brighter when you work at Sun Life
At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We're proud to be recognized in our communities as a top employer. Proudly Great Place to Work® Certified in Canada and the U.S., we've also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row. Visit our website to learn more about our benefits and recognition within our communities.
We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email thebrightside@sunlife.com to request an accommodation.
For applicants residing in California, please read our employee California Privacy Policy and Notice.
We do not require or administer lie detector tests as a condition of employment or continued employment.
Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
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