The DNCM holds the responsibility for overseeing and finalizing designated disability claims. This entails ensuring the completeness and comprehensiveness of each member's claim file, particularly concerning the medical records associated with the diagnosis(es) under review. The DNCM is also tasked with ensuring the quality assurance of the PR’s Report, aiming to eliminate clinical and administrative errors. The scope of claims encompasses New Claims, Appeals, Periodic Reviews, Annual Reviews, and other specified claim types. The DNCM is committed to facilitating an efficient, timely, and thorough disability claim review process.

Role and Responsibilities

·         A thorough and comprehensive review of disability applications to include: ·         A review of the claim file, specifically the clinical components, in its entirety ·         The compilation of applicable information through outreach to providers, disability applicants, employers, and other applicable parties ·         Review and analysis of all information received from all parties directly or indirectly related to the disability application and/or that information obtained during the triage process ·         Appropriate specialty identification of Medical Board PRs. ·         As a primary function, perform outreach to the medical provider(s), disability applicant, and/or employer, and other necessary providers so to gather additional information and/or clarify information for the purpose of assisting in the PR’s analysis and decision-making associated with the disability recommendation ·         In a consistent and detailed manner, document activity associated with each claim to include detailed information regarding outreach attempts, outreach communication, information/medical record analysis, and all other case information. ·         Determine receipt of necessary and complete information with which to sufficiently perform the triage function. ·         Identify the need for a case to be escalated to a supervisor or the AMD for further review, inquiry, and/or decision-making. ·         Perform QA of Medical Board reports in draft form and ensure overall quality of reports, including but not limited to clinical and administrative compliance; clinical support and rationale; grammatical and typographical review; and overall compliance to client standards.  ·         Work with the PR during the QA process to address any outstanding quality and/or compliance issues, consistent with company policy and procedure. ·         Communicate with PR during the QA process, as necessary, to ensure Medical Board report timeliness. ·         Complete tasks associated with specific cases in the scheduled timeframes and provide updates in the system accordingly upon completion. ·         Ensure completeness and accuracy of all case paperwork and documents. ·         Keep clients informed of case progress, as needed. (i.e., delays, etc.). ·         Ensure timely and appropriate communication with clients on the status of open or pending cases, as requested. ·         Identify disability triage and QA process quality improvement opportunities. ·         DCR huddle and other meeting participation, as appropriate. ·         Other duties, as deemed appropriate.   Required Qualifications and Education ·         Unrestricted RN licensure, without sanctions, to practice in a state within the United States of America ·         Minimum two (2) years of DNCM experience or minimum two (2) years of work experience to include case management and/or claim management of Disability and/or Workers’ Compensation claims ·         Demonstrated ability to successfully perform disability claims management reviews ·         Critical thinking skills ·         Good decision-making skills ·         Detail-oriented ·         Ability to work autonomously, as well as within a team structure ·         Ability to travel to onsite client meetings when attendance is required ·         Strong organizational skills with attention to detail ·         Ability to prioritize workload ·         Excellent written and verbal communication skills – clear, concise, appropriate grammar and punctuation, vocabulary, content, etc. ·         Proficiency in Microsoft Office software applications ·         Ability to adapt to a dynamic work environment   Preferred Skills and Additional Experience ·         Bachelor’s degree in health or management-related field ·         Minimum five (5) years clinical experience ·         Prior leadership experience   ​​Additional Notes​  When attending any internal or external virtual meetings, camera use is required.