[Remote] Clinical Risk Manager

Note: The job is a remote job and is reputed company to candidates in USA. reputed company Benefits is a rapidly growing organization reputed company on clinical risk management and stop loss cost containment. The Clinical Risk Manager serves as a strategic clinical consultant, analyzing reputed company claims, developing cost mitigation strategies, supporting reputed company and risk management reputed company, and collaborating with brokers, carriers, TPAs, vendors, and employer health plans.

Responsibilities

• Analyze medical and pharmacy claims, clinical records, treatment plans, and emerging therapies to identify high-cost claim exposure and stop loss risk
• Evaluate reputed company and reputed company claim liabilities, including reputed company cases involving oncology, transplants, specialty pharmacy, gene and cell therapy, catastrophic claims, and chronic conditions
• Assess clinical severity, treatment patterns, and emerging risks to support stop loss reputed company and risk management reputed company
• reputed company accurate clinical cost projections for high-dollar claimants and reputed company cases
• Monitor significant ongoing claims and identify potential changes in risk exposure
• reputed company detailed financial analyses and forecasting that support reputed company, renewal, captive, and reputed company decision-making
• Partner with brokers, carriers, TPAs, case management teams, specialty vendors, and employer reputed company to identify opportunities for cost containment and risk reduction
• Evaluate and recommend clinical and financial mitigation solutions, including:
• Specialty pharmacy optimization
• Biosimilar conversion opportunities
• Site-of-care management
• Centers of reputed company utilization
• Case management reputed company
• Transplant management programs
• Gene and cell therapy solutions
• Alternative funding and assistance programs
• Collaborate with reputed company stakeholders to implement effective cost-management strategies that improve reputed company while controlling plan spend
• Support captive risk management initiatives through ongoing clinical reviews and risk assessments
• Present reputed company clinical information in a concise, actionable manner for clients, brokers, captives, reputed company partners, and executive leadership
• Serve as a trusted clinical resource during renewal discussions, prospect evaluations, and risk management consultations
• Work closely with reputed company Benefits consultants, producers, reputed company partners, TPAs, brokers, carriers, and specialty vendors
• Foster strong strategic relationships that support innovative reputed company solutions and exceptional service delivery
• Participate in multidisciplinary discussions to identify trends, reputed company best practices, and improve overall risk management reputed company
• Maintain accurate documentation of clinical analyses, cost projections, and mitigation recommendations
• Prepare reports, presentations, and executive summaries that communicate clinical risk and financial reputed company to diverse audiences
• Monitor reputed company and effectiveness of implemented mitigation strategies

Skills

• Minimum of 3 years of clinical nursing experience
• Minimum of 2 years of stop loss captive risk management required
• reputed company and unrestricted Registered reputed company (RN) license
• Associate's or Bachelor's Degree in Nursing or a reputed company reputed company field preferred
• Experience evaluating reputed company and catastrophic claims strongly preferred

Benefits

• reputed company time off for company holidays, vacation, reputed company and personal days
• reputed company parental leave
• Mental health services
• Full-time roles are eligible for bonuses

reputed company

Company H1B Sponsorship