Our client specializes in
employer-sponsored group medical insurance . They offer an exciting new
position within the captive division. The clinical support staff helps
insureds understand the financial costs associated with critical medical
cases. As Clinical Risk Manager you'll be involved in the analysis and
consultation of complex medical cases which often times require
specialized care.
Clinical Risk Manager Responsibilities:
Assists underwriters in the evaluation and assessment of clinical
data.
Evaluate quote, disclosure and renewal business opportunities for
known and potential risk
Facilitate successful client interaction to clarify/gain clinical
information to improve pricing of proposed risk.
Provide detailed and concise reporting of initial, updated and final
recommendations.
Monitors and if applicable, impacts anticipated risk once case is
sold.
Early and claim notice management.
Facilitate timely and accurate intake, screening, triaging and
tracking of potential claim notifications and associated
reports/documentation.
Determine potential for impact and recommend alternative care and cost
management solutions.
Establish necessary reserves and anticipate ongoing financial risk.
Document reserves into appropriate database.
Monitor and provide necessary interaction and documentation of
activities of the case until closure.
Record outcomes (internal and external benefits).
Provides individual consultative case management services to clients’
medical management personnel.
Performs general assessments of clients’ medical management strategies
and identifies areas where support from external sources is warranted.
Clinical Risk Manager
Qualifications:
Requires BA/BS or higher
in a health related field and licensure as a health professional, or
certification as a care manager, or current unrestricted RN license in
applicable state(s) and 3 years clinical experience.
5+ years of case
management and insurance/reinsurance experience.
Group medical, stop loss or reinsurance knowledge experience is
helpful.
Must have strong oral,
written and interpersonal communication skills, PC skills to include
word processing, spreadsheet, and database applications,
organizational and problem-solving skills, and decision-making skills.
Please contact Scot Dickerson for immediate confidential consideration
and additional details.
If you would like to submit
your resume for this insurance job, please click HERE
and attach your resume as a Microsoft Word document.
Capstone
Insurance Search Group is a search firm dedicated to the insurance
industry. We work nationally
with expertise that spans top executives, middle management and
technical level positions. We can provide assistance with a variety of
product lines to include Property and Casualty, Life, Health,
Disability, Annuity and Pension. We will provide you with a service that
is of the highest degree of confidentiality, professionalism and
integrity.
