Director of Clinical & Cost Containment, Employee Benefits

HUB International • Atlanta, GA

46d • $130,000 - $150,000 • Hybrid

About The Position

The Director of Clinical & Cost Containment is a senior strategic role within Strategic Benefit Resources (SBR) responsible for leading the clinical consulting and cost containment program capabilities that differentiate SBR's self-funded solutions in the wholesale distribution market. This individual serves as the primary clinical subject matter expert across SBR's book of business, partnering with sales, distribution, and stop-loss consulting teams to evaluate, implement, and communicate clinical cost containment strategies that drive measurable financial outcomes for employer clients. This role bridges clinical expertise and consultative sales support — working directly with broker/consultant partners, TPAs, stop-loss carriers, and employer plan sponsors to identify high-cost claim drivers, optimize vendor program selection, and develop clinical frameworks that reduce plan cost and improve member outcomes.

Requirements

• Bachelor's degree in Nursing, Healthcare Administration, Health Sciences, or a related clinical field; RN license strongly preferred.
• 5+ years of experience in clinical cost containment, case management, utilization management, stop-loss, or self-funded health plan consulting.
• Deep knowledge of self-funded employer benefit plan design, stop-loss insurance structures, and the TPA/wholesale distribution market.
• Demonstrated understanding of medical coding (ICD-10, CPT), clinical guidelines, and claims adjudication processes.
• Experience working with or evaluating cost containment vendors including case management, PBMs, reference-based pricing, and specialty drug management programs.
• Strong analytical and data interpretation skills; ability to translate clinical findings into financial and strategic insights.
• Excellent communication, presentation, and relationship management skills with broker, consultant, and employer-level audiences.

Nice To Haves

• Certification in Case Management (CCM), Certified Employee Benefit Specialist (CEBS), or equivalent professional credential.
• Experience with pharmacy carve-out structures and Rx cost containment programs in the self-funded context (e.g., PMPM guarantee models, closed formulary programs).
• Familiarity with all types of self funded arrangements including captive insurance structures, level-funded plans, or consortium-based stop-loss arrangements.
• Prior experience in a wholesale benefits distribution, MGU, or TPA environment.
• Working knowledge of ERISA, HIPAA, ACA implications for self-funded plan sponsors.

Responsibilities

• Lead the development and ongoing refinement of SBR's clinical cost containment framework, aligning strategies with market trends and client needs.
• Evaluate, vet, and recommend cost containment vendors and programs (utilization management, case management, pharmacy benefit management, transplant networks, reference-based pricing, direct primary care, etc.).
• Analyze claims data, clinical utilization trends, and high-cost claimant profiles to identify actionable savings opportunities.
• Monitor medical cost trends, specialty drug pipelines, and catastrophic claim drivers to proactively advise clients and sales teams.
• Review TPA trigger reports and claim referrals to surface impending high-cost diagnoses and recommend clinical risk mitigation actions.
• Identify and communicate coverage gap risks when Rx is carved out of stop-loss contracts or when benefit plan design creates clinical exposure.
• Serve as clinical liaison between SBR, stop-loss carriers, TPAs, and employer plan sponsors on complex claims and risk management issues.
• Support SBR's sales and consulting teams with clinical presentations, client-facing materials, and technical talking points for broker/consultant audiences.
• Conduct clinical reviews and plan analyses for prospective and existing employer clients, translating clinical findings into financial impact narratives.
• Develop educational resources, webinars, and market-facing content that position SBR's clinical expertise as a competitive differentiator.
• Partner with distribution leadership and brokers/consultants to align cost containment program recommendations with individual client risk profiles and plan designs.
• Build and maintain relationships with clinical cost containment vendors, including case management firms, utilization review organizations, PBMs, and specialty program providers.
• Evaluate vendor performance through KPI monitoring, outcome tracking, and savings validation.
• Negotiate program terms and coordinate seamless integration of clinical vendors within the SBR distribution ecosystem.
• Stay current on regulatory developments, ERISA compliance requirements, and clinical best practices affecting self-funded plan design.
• Partner with the Chief Strategy Officer, COO, and sales leadership to align clinical strategy with SBR's overall growth objectives.
• Provide clinical training and education to internal SBR teams, ensuring consultants can confidently represent cost containment solutions.
• Contribute to the development of SBR's strategic plan as it relates to clinical program expansion, new vendor partnerships, and market positioning.

Benefits

• Comprehensive health, dental, and vision benefits
• Retirement plan with employer contribution
• Professional development and continuing education support
• Hybrid/remote work flexibility
• Paid-time-off benefits such as vacation, sick, personal, floating holidays and company holidays
• Eligible annual bonuses, equity and commissions may be available for some positions

What This Job Offers

• Job Type: Full-time
• Career Level: Senior