Clinical Risk Manager

Ryan Specialty

6d

About The Position

We are seeking a highly skilled and experienced Stop Loss Clinical Risk Manager to join our team. The ideal candidate will have a strong clinical background and demonstrated expertise in evaluating and managing stop loss claims. This role includes analyzing clinical data, assessing potential risks, recommending mitigation strategies to key stakeholders, and providing cost projections that support our sales, underwriting, claims, and risk management services. What will your job entail? Job Description

Requirements

• Education: Associate or Bachelor's degree in Nursing or a related field is preferred.
• Experience: At least 3 years of clinical experience, with a minimum of 1 year in stop loss nursing or clinical risk management.
• Licensure: Current and valid Registered Nurse (RN) license.
• Skills: Strong analytical and problem-solving skills. Excellent written and verbal communication skills. Ability to work effectively within the clinical team and across the multidisciplinary teams we support Proficiency in Microsoft Office Suite (Outlook, Word, Excel, PowerPoint, Copilot). Ability to work independently and manage multiple projects simultaneously.

Nice To Haves

• Experience in oncology, gene and cell therapy and transplants is a plus

Responsibilities

• Clinical Data Analysis: Review and analyze clinical data to assess potential stop loss claim liabilities.
• Cost Projections: Provide cost projections on high-dollar claimants to support underwriting decisions.
• Case Management Oversight: Utilize case management techniques to ensure effective cost containment and management of high-risk claims.
• Collaboration: Work closely with Third Party Administrators (TPAs), case managers, and internal teams to ensure effective communication and management of clinical information.
• Documentation: Maintain accurate and detailed documentation of clinical assessments, cost projections, and case management activities.
• Risk Assessment: Identify high-risk individuals and communicate required stop loss cost analysis based on current clinical conditions and future cost projections.
• Reporting: Prepare and present reports on clinical risk assessments and cost projections to senior management.

Benefits

• In addition to paid time off for company holidays, vacation, sick and personal days, Ryan offers paid parental leave, mental health services and more.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees