Clinical Risk Manager

Ryan Specialty

12d•$103,565 - $120,000•Remote

About The Position

Ryan Specialty Benefits is seeking an experienced and clinically driven Clinical Risk Manager to join our dynamic Clinical Advisory Team. This is a unique opportunity to play a critical role within a rapidly growing organization that is redefining clinical risk management and stop loss cost containment. As a Clinical Risk Manager, you will serve as a strategic clinical consultant, partnering closely with our brokers, carrier partners, TPAs, captive programs, specialty vendors, and employer-sponsored health plans to identify risk, evaluate high-cost claims, and develop innovative cost mitigation strategies. Your expertise will directly influence underwriting decisions, risk management initiatives, and financial outcomes for our clients. This role is ideal for a clinically experienced Registered Nurse who enjoys combining clinical expertise with financial analysis, strategic problem-solving, and collaborative relationship management. You will become part of a highly engaged team focused on delivering meaningful results through clinical insights, proactive risk identification, and innovative mitigation solutions.

Requirements

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

Responsibilities

Analyze medical and pharmacy claims, clinical records, treatment plans, and emerging therapies to identify high-cost claim exposure and stop loss risk.
Evaluate current and future claim liabilities, including complex 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 underwriting and risk management decisions.
Develop accurate clinical cost projections for high-dollar claimants and complex cases.
Monitor significant ongoing claims and identify potential changes in risk exposure.
Provide detailed financial analyses and forecasting that support underwriting, renewal, captive, and carrier decision-making.
Partner with brokers, carriers, TPAs, case management teams, specialty vendors, and employer groups 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 Excellence utilization, Case management intervention, Transplant management programs, Gene and cell therapy solutions.
Collaborate with internal and external stakeholders to implement effective cost-management strategies that improve outcomes while controlling plan spend.
Support captive risk management initiatives through ongoing clinical reviews and risk assessments.
Present complex clinical information in a concise, actionable manner for clients, brokers, captives, carrier partners, and executive leadership.
Serve as a trusted clinical resource during renewal discussions, prospect evaluations, and risk management consultations.
Work closely with Ryan Specialty Benefits consultants, producers, underwriting partners, TPAs, brokers, carriers, and specialty vendors.
Foster strong strategic relationships that support innovative client solutions and exceptional service delivery.
Participate in multidisciplinary discussions to identify trends, share best practices, and improve overall risk management outcomes.
Maintain accurate documentation of clinical analyses, cost projections, and mitigation recommendations.
Prepare reports, presentations, and executive summaries that communicate clinical risk and financial impact to diverse audiences.
Monitor outcomes and effectiveness of implemented mitigation strategies.