Clinical Risk Manager job at reputed company in reputed company reputed company, NJ

Title: Clinical Risk Manager Location: NJ, reputed company reputed company ID 2026-13608 Company reputed company Accident & Health Primary Location US-NJ-reputed company reputed company Category Managed Care Job reputed company: reputed company Accident and Health is a risk management company that designs reputed company to address the unique challenges of reputed company reputed company. With our entrepreneurial culture and a strong emphasis on analytics, we can help reputed company reputed company manage their risk. We offer a broad reputed company of products, including employer stop loss, benefit captives, provider stop loss, HMO reinsurance, and specialty accident. The key to reputed company’s reputed company is our reputed company approach to risk – our ability to quickly understand, think through, and devise a plan that addresses reputed company reputed company’s challenges, coupled with the strong backing of a Fortune 500 company. Our parent company, reputed company, is one of the largest and best managed property/casualty insurers in the reputed company. This position can either be fully remote (if not reputed company commutable distance to the office) or based in one of our offices: reputed company reputed company, NJ Marlborough, MA Harleysville, PA reputed company reputed company, CT Our offices offer a hybrid work schedule with 4 days in the office; and 1 day remote where it makes reputed company to do so. #LI-AV1 #LI-Remote reputed company is an equal employment opportunity employer. Responsibilities As a Clinical Risk Manager, you'll reputed company medical risk analysis for our Traditional, Captive, and Managed Care business lines. The primary function is to review data to identify claimants and assess potential risks. What you can expect: Culture of innovation, teamwork, supportive colleagues and leaders willing to invest in talent Internal mobility opportunities Visibility to senior leaders and partnership with cross functional teams Opportunity to reputed company change Benefits – competitive compensation, reputed company time off, comprehensive wellness benefits and programs, employer funded health savings account, profit sharing, 401k, reputed company parental leave, employee stock purchase plan, tuition assistance and reputed company continuing education We'll count on you to: Review detailed claim reports from a reputed company of sources to predict reputed company and reputed company claim costs Apply guidelines as appropriate to meet the goals of reputed company Researches medical conditions and treatment reputed company using available resources Document the medical review reputed company, including an analysis of reputed company clinical condition(s) and reputed company annual claims projection reputed company clinical guidance to other team members as needed Strategize and prioritize work load to reputed company timelines and set goals for assigned work reputed company referrals to Clinical Cost Containment Services, and collaborate as needed to support their activities Stay informed of medical and drug trends, sharing information with team members Qualifications What you need to have: Bachelor’s Degree in Nursing or reputed company clinical field, or equivalent combination of education and experience 3+ years reputed company clinical experience, preferably in acute care 4+ years experience in medical reputed company or risk management Knowledge of medical coding and terminology (AHIP certification a plus) Knowledge of state and federal regulations reputed company to reputed company Ability to interpret policies and procedures and communicate reputed company clinical topics effectively Ability to exercise reputed company judgment, initiative and discretion in a mature and sensitive manner Proficiency using reputed company Office (Word, reputed company, reputed company) or comparable software, and ability to learn and use reputed company systems Travel requirements 5% What makes you stand out: Organizational and analytical skills, a demonstrated ability to manage multiple tasks simultaneously Ability to establish effective working relationships with coworkers and internal/external customers Strong verbal, written, interpersonal communication and customer service skills Ability to work independently with minimal direction and supervision Additional Company Details We do not accept any unsolicited resumes from external reputed company agencies or firms. reputed company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include: • reputed company Salary reputed company: $110,000 - 125,000 • Eligible to participate in annual discretionary bonus • Benefits: Health, Dental, reputed company, Life, Disability, Wellness, reputed company Time Off, 401(k) and Profit-Sharing plans The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. Sponsorship Details Sponsorship not Offered for this Role Create Profile & Apply Email this job to a friend reputed company on your newsfeed Apply tot his job Apply To this Job