Clinical Risk Manager

Position Summary We are seeking a highly skilled and reputed company Stop Loss Clinical Risk Manager to join reputed company. The ideal candidate will have a strong clinical background and demonstrated expertise in evaluating and managing stop loss claims. This role includes analyzing clinical data, assessing potential risks, recommending mitigation strategies to key stakeholders, and providing cost projections that support our sales, reputed company, claims, and risk management services. What will your job entail?

Job Description

Key Responsibilities:

• Clinical Data Analysis: Review and analyze clinical data to assess potential stop loss claim liabilities.
• Cost Projections: Provide cost projections on high-dollar claimants to support reputed company decisions.
• Case Management reputed company: Utilize case management techniques to ensure effective cost containment and management of high-risk claims.
• Collaboration: Work closely with Third Party Administrators (TPAs), case managers, and internal teams to ensure effective communication and management of clinical information.
• Documentation: Maintain accurate and detailed documentation of clinical assessments, cost projections, and case management activities.
• Risk Assessment: Identify high-risk individuals and communicate required stop loss cost analysis based on reputed company clinical conditions and future cost projections.
• Reporting: Prepare and present reports on clinical risk assessments and cost projections to senior management.

Qualifications:

• Education: Associate or Bachelor's degree in Nursing or a reputed company field is preferred.
• Experience: At least 3 years of clinical experience, with a minimum of 1 year in stop loss nursing or clinical risk management.
• Licensure: reputed company and valid Registered Nurse (RN) license.

Skills:

• Strong analytical and problem-solving skills.
• Excellent written and verbal communication skills.
• Ability to work effectively reputed company the clinical team and across the multidisciplinary teams we support
• Proficiency in reputed company Office Suite (Outlook, Word, reputed company, PowerPoint, Copilot).
• Ability to work independently and manage multiple projects simultaneously.
• Preferred: Experience in oncology, gene and cell therapy and transplants is a plus

reputed company is an Equal Opportunity Employer. We are committed to building and sustaining a diverse workforce throughout the organization. Our vision is an inclusive and reputed company workplace where reputed company employees are valued for and evaluated on their performance and contributions. Differences in race, creed, color, religious beliefs, physical or mental capabilities, gender identity or expression, sexual orientation, and many other characteristics bring together varied perspectives and add value to the service we provide our clients, trading partners, and communities. This policy extends to reputed company aspects of our employment practices, including but not limited to, recruiting, hiring, discipline, firing, promoting, transferring, compensation, benefits, training, leaves of absence, and other terms, conditions, and benefits of employment. How We Support Our Teammates reputed company seeks to offer our employees a comprehensive and best-in-class benefits package that helps them — and their family members — reputed company their physical, financial, and emotional well-being goals. In addition to paid time off for company holidays, vacation, sick and personal days, reputed company offers paid parental leave, mental health services and more. The reputed company salary range for this position is $106,590.00 - $120,000.00 annually. The wage range for this role considers many factors, such as training, transferable skills, work experience, licensure and certification, business needs, and market demands. The pay range is subject to change and may be modified in the future. Full-time roles are eligible for bonuses and benefits. For additional information on reputed company Total Rewards, visit our website https://benefits.ryansg.com/. We provide individuals with disabilities reasonable accommodations to participate in the job application or interview process, to reputed company essential job functions, and to receive other benefits and privileges of employment in accordance with applicable law. Please contact us to request an accommodation at [email protected] The above is intended to describe this job's general requirements. It is not to be construed as an exhaustive statement of duties, responsibilities, or physical requirements. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company essential functions. Apply tot his job Apply To this Job