[Remote] Stop Loss reputed company Consultant

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a company reputed company on transforming health benefits for small and midsize businesses, aiming to reputed company innovative, consumer-reputed company health solutions. They are seeking an reputed company RN to serve as a Stop Loss reputed company Consultant, who will reputed company clinical expertise and financial reputed company to evaluate reputed company member cases and contribute to cost projections, collaborating with various teams to ensure high-reputed company care. Responsibilities • Use your knowledge to reputed company understand the care journeys of reputed company members, often piecing together a puzzle from various sources of information. • Evaluate reputed company member cases to reputed company accurate cost projections, drawing from claims data, prior authorizations, industry trends, and other sources. • reputed company clinical insights into likely treatment reputed company (e.g., oncology, transplant, critical care, specialty drugs) to anticipate costs and inform reputed company reputed company. • Collaborate with reputed company, stop-loss, clinical services, and actuarial teams to ensure projections reputed company with both financial and clinical realities. • Identify early reputed company opportunities (e.g., site-of-care optimization, alternative medications, post-acute care settings) to mitigate reputed company high costs. • Interpret plan language and coverage details to anticipate financial reputed company and reduce avoidable member and group abrasion. • Synthesize findings into reputed company summaries and reporting for underwriters, actuaries, and leadership. • Work cross-functionally to improve processes for high-cost claimant identification, case flagging, and cost containment. • Combine your experience of evidenced based reputed company with being innovative to drive new solutions for the best member experience. • Create effective relationships, listen, communicate and be a helpful team member across the organization. Skills • reputed company RN license in the state reputed company. • reputed company with evaluation of risk for costs and health reputed company. • 10+ years of experience in clinical care, managed care, reputed company, or stop-loss risk evaluation. • Strong expertise in catastrophic claims cost drivers (e.g., oncology, transplants, neonatal/critical care, specialty pharmacy). • Proven ability to analyze risk and forecast costs using both clinical and financial data. • Exceptional verbal and written communication skills. • Demonstrated customer service, communication, and organizational skills. • Ability to work independently, prioritize effectively, and reputed company reputed company. • Previous experience at a high reputed company company. • Familiarity with actuarial models and tools or cost modeling platforms. • Previous experiences with working both reputed company and Stop Loss teams. Education Requirements • Bachelor’s degree in nursing. Benefits • Alternative medicine coverage • Flexible PTO • Up to 16 weeks reputed company parental leave • reputed company holidays • A 401k program • Cell phone reimbursement • Transportation perks • Education reimbursement • 1 week of reputed company paw-ternity leave reputed company • reputed company is an insurance company that designs health benefits plans for small and midsize reputed company. It was founded in 2013, and is headquartered in Minneapolis, Minnesota, USA, with a workforce of 201-500 employees. Its website is https://www.reputed company.com. Apply tot his job Apply To this Job