Clinical Risk Manager
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Job Description
Stop Loss Clinical Risk Manager at Ryan Specialty evaluating and managing stop loss claims and analyzing clinical data. Collaborating with various stakeholders and maintaining documentation for effective risk management.
Responsibilities:
- Review and analyze clinical data to assess potential stop loss claim liabilities
- Provide cost projections on high-dollar claimants to support underwriting decisions
- Utilize case management techniques to ensure effective cost containment and management of high-risk claims
- Work closely with Third Party Administrators (TPAs), case managers, and internal teams to ensure effective communication
- Maintain accurate and detailed documentation of clinical assessments, cost projections, and case management activities
- Identify high-risk individuals and communicate required stop loss cost analysis
- Prepare and present reports on clinical risk assessments and cost projections to senior management
Requirements:
- At least 3 years of clinical experience
- Minimum of 1 year in stop loss nursing or clinical risk management
- Current and valid Registered Nurse (RN) license
- Strong analytical and problem-solving skills
- Excellent written and verbal communication skills
- Proficiency in Microsoft Office Suite (Outlook, Word, Excel, PowerPoint, Copilot)
Benefits:
- Paid time off for company holidays
- Vacation
- Sick and personal days
- Paid parental leave
- Mental health services
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