Clinical Risk Manager

Berkley•Hamilton Township, NJ

22h•$110,000 - $125,000•Hybrid

About The Position

As a Clinical Risk Manager, you'll perform 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 impact change Benefits – competitive compensation, paid time off, comprehensive wellness benefits and programs, employer funded health savings account, profit sharing, 401k, paid parental leave, employee stock purchase plan, tuition assistance and professional continuing education

Requirements

Bachelor’s Degree in Nursing or related clinical field, or equivalent combination of education and experience
3+ years direct clinical experience, preferably in acute care
4+ years experience in medical underwriting or risk management
Knowledge of medical coding and terminology (AHIP certification a plus)
Knowledge of state and federal regulations related to underwriting
Ability to interpret policies and procedures and communicate complex clinical topics effectively
Ability to exercise sound judgment, initiative and discretion in a mature and sensitive manner
Proficiency using Microsoft Office (Word, Excel, Outlook) or comparable software, and ability to learn and use complex systems
Travel requirements 5%

Nice To Haves

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

Responsibilities

Review detailed claim reports from a variety of sources to predict current and future claim costs
Apply guidelines as appropriate to meet the goals of the company
Researches medical conditions and treatment options using available resources
Document the medical review clearly, including an analysis of current clinical condition(s) and future annual claims projection
Provide clinical guidance to other team members as needed
Strategize and prioritize work load to achieve timelines and set goals for assigned work
Make 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