Department SAMDEX
Category Benefits
City National
State
Travel
Involved
10-20%
Type of
Position
Full-Time

Sr. Clinical Risk Mgr (RN)

AFA / SALL

Description:

*Provide consulting services for internal and external clients and their delegated entities in order to promote a thorough understanding of current and anticipated clinical needs and expected claims costs while facilitating the use of unique solutions to insure optimal care and claims outcomes.

*Play an integral role in support of our vision to be recognized as the industry leader in risk management services by assuring optimal clinical outcomes are obtained at a cost commensurate with the level of medical services rendered while also promoting client satisfaction and retention

.

*Provide valuable catastrophic and potentially catastrophic claim insight for Underwriting Colleagues to assist them in pricing and setting terms on prospective and renewal customers.

Requirements:

Bachelor’s Degree From Four-Year College or University Nursing/Health area of study required

BA/BS or higher in Nursing/health related field with 5-7 years clinical experience, or Associate or Diploma Degree and 7-10 years clinical experience with a  current unrestricted license as a health professional

5 to 7 years

•Group medical, managed care, health insurance, stop loss, or reinsurance experience

•Able to set goals and handle multiple tasks, clients, and projects simultaneously; able to appropriately balance priorities, deadlines and deliverables. Able to quickly adapt to change, work under tight deadlines and stressful conditions.

•Intermediate level of investigative, analytical, and problem-solving skills

•Ability to use varying resources to research diagnoses, treatments and average costs

•Expert negotiating, persuasion, and conflict resolution skills

•Ability to work well within a team and actively participate in team projects

•Must have excellent oral, written, and interpersonal communication skills. PC skills to include word processing, spreadsheet, and database applications. Intermediate typing skills.

•Maintain regular and predictable attendance

•Ability to travel 15%

Current, unrestricted license as a health professional

CCM, CRRN, or CPUM preferred