Unit Manager - Operations

Description and Requirements
Job Responsibilities
• Provides professional medical, technical, consulting advice, and recommendations in support of claims
evaluation, investigation, and assessment for various claims-related departments, while managing assigned
caseload of complex cases applying specialized training and knowledge to the assessment of cases and acting
as a resource on clinical and technical issues.
• Conducts complex research, review and analysis of medical records, treatment plans and claim information.
• Provides recommendations regarding claimants' current potential functional abilities and develops
goal-focused return-to-work plans.
• Assess training needs and creates, authors, and presents medical training to claim and business partner
associates.
• Engages claimants, healthcare providers, employers, and customers to ensure strict adherence in determining
functional abilities.
• Engages claimants, health care providers and employers in return to work potential and planning while
coaching claim specialists on identifying and acting upon return-to-work potential.
• Creates effective requests for medical information which focus on clarifying medical restrictions and
limitations and their impact on work functionality. Performs other related duties as assigned or required
Education, Technical Skills & Other Critical Requirement
Education
Bachelor's degree (Medical) or diploma with a minimum of 15 years of education
Master's degree in clinical psychology or social work.
If Registered Nurse will accept associate degree or higher with current RN state license
(Anyone from below)
• Nursing + MS (Master of Science) in Psychology
• Nursing + MS (Master of Science) in Psychiatry
• Nursing + BA (Bachelor of Arts) in Psychology
• MA (Master of Arts) in Psychology + PhD (Doctor of Philosophy) in Psychology
• MPhil in Clinical Psychology
• Licensed Clinical Psychologist-licensed in behavioral unit
• Options -Licensure, social work, professional counselling
• MS (Master of Science) in Psychology with 2 years of clinical experience
• MS (Master of Science) in Psychiatry with 2 years of clinical experience
• MA (Master of Arts) in Psychology with 2 years of clinical experience
• MPhil in Clinical Psychology with 2 years of clinical experience
• MBBS + Diploma/Degree in Psychiatry +2 years of Clinical experience
Experience
(In Years)
Required
• Current RN licensure
• 2 + y ears of experience as an RN with Clinical/Ops Experience (Specially in Physiatry/Psychology)
Preferred
• 2+ years Disability claims and/or clinical experience
• Licensure in Clinical Psychology or Social Work & 2 years of experience in inpatient or intensive outpatient or outpatient therapy in a clinical setting
• Value added- Nursing background with behavior health (including MHU +BHU)
• Disability claims experience
• Preferred designations CCM (certified case management) and/or CDMS (certified disability management specialist).
Technical Skills/other skills
• Computer navigation skills
• Excellent Keyboarding and data entry speed
• Knowledge about US Culture is preferred.
• Excellent verbal/written communication skills - should be able to read, interpret business documents.
• Excellent analytical and interpersonal skills
• Data gathering ability/ Eye for detail.
• Ability to comprehend and apply varied rules to multiple policies.
• Teamwork/ Managing Self / Adaptability
• Ability to work successfully and perform detail-oriented work in production driven environment.
• Excellent organizational skills
• Proven ability to meet quality and time standards.
• Ability to work on routine/standardized transactions.
• Possess strong knowledge of medical conditions, symptoms, and terminology.
Other Critical Requirements Like Voice/ Non-Voice for Insurance Ops
Blended
Complexity Scale: 9/T5C5
About MetLife
Recognized on Fortune magazine's list of the "World's Most Admired Companies" and Fortune World's 25 Best Workplaces™, MetLife, through its subsidiaries and affiliates, is one of the world's leading financial services companies; providing insurance, annuities, employee benefits and asset management to individual and institutional customers. With operations in more than 40 markets, we hold leading positions in the United States, Latin America, Asia, Europe, and the Middle East.
Our purpose is simple - to help our colleagues, customers, communities, and the world at large create a more confident future. United by purpose and guided by our core values - Win Together, Do the Right Thing, Deliver Impact Over Activity, and Think Ahead - we're inspired to transform the next century in financial services. At MetLife, it's #AllTogetherPossible . Join us!
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