Compensation:

Salary Range: $76 000 - 120 000

Bonus: 10% Target

PartnerRe Health, the global Health Division of PartnerRe, is an acknowledged leader in providing risk management solutions to accident and health markets. The PartnerRe team of experienced professionals develops innovative, client-specific solutions by thoroughly understanding our clients' goals, market, risk tolerance and exposures. Using a suite of proven proprietary financial and analytical tools, an effective risk management program is designed with extensive support services.

SCOPE AND RESPONSIBILITIES:

The PULSE Clinical Consultant role is to serve as risk managers, working closely with our clients internal stakeholders to educate, validate, collaborate and solve complex and costly medical reimbursement issues. As clinical experts, our clinical consultants are able to identify and understand a clients' risk profile, educate on how to more effectively manage that risk and work with a variety of specialty service providers to generate optimal outcomes both clinically and financially. They provide clinical expertise to PartnerRe's underwriting and claims departments to ensure insightful administration of PartnerRe Health's products.

JOB DUTIES:

The following reflects management's definition of essential functions for this position but does not restrict the responsibilities that may be assigned. Management may assign or reassign duties and responsibilities to this job at any time due to reasonable accommodation or other reasons.

• Conduct clinical disclosure reviews with Underwriting to assess risk and support stop loss and reinsurance underwriting decisions.
• Review high-cost claims, trigger reports, and 50% notices to identify catastrophic diagnoses, emerging risks, and intervention opportunities.
• Complete clinical risk assessments using medical, claims, and financial information.
• Collaborate with Underwriting, Claims, and Sales team to provide clinical expertise and seamless client experience.
• Identify and recommend cost containment strategies, including transplant networks, specialty care, case management, and specialty pharmacy solutions.
• Analyze complex transplant, specialty drug, and cell and gene therapy cases to recommend optimal solutions.
• Serve as a clinical resource to clients, brokers, and other stakeholders regarding high-cost medical risks.
• Utilize internal software and documentation systems to analyze risk, document, track, prioritize, and manage cases.
• Monitor cases approaching or exceeding the reinsurance layer and communicate significant developments to key stakeholders.
• Maintain current knowledge of emerging treatments, specialty drugs, cell and gene therapies, and stop loss industry trends.

QUALIFICATIONS:

Computer Skills

• Must be proficient in Microsoft programs including but not limited to Excel, Access, Outlook and Word. Must be able to learn other software programs required by the department.

Education and/or Experience

• Current, unrestricted Registered Nurse (RN) license.
• Bachelor's degree preferred; Associate degree in Nursing (ADN) with equivalent clinical experience will be considered.
• 5+ clinical nursing experience required.
• 1-3 years of stop loss, health insurance, reinsurance, utilization management, case management, or related managed care experience preferred.
• Experience with catastrophic claims, transplant, oncology, specialty pharmacy, infusion therapy, or cell and gene therapy preferred.
• Certified Case Manager (CCM) preferred.

Other Skills and Abilities

• Must have or be able to quickly acquire knowledge of departmental program structure (mission, goals and objectives), department policies and procedures.
• Must have a sound knowledge and ability in business correspondence and an ability to proofread for grammar, spelling and punctuation with a high degree of accuracy.
• Must be able to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rates, obtain ratios and percentages and to draw and interpret bar graphs.
• Must maintain professional and technical expertise through participation in continuing education as necessary.
• Ability to handle multiple interruptions and adjustments to priorities throughout the day.
• Ability to communicate effectively with diverse individuals and to calmly and efficiently handle situations ranging from routine to urgent.
• Excellent memory and organizational ability, in order to set priorities, organize workload, handle multiple responsibilities and meet deadlines.
• Proficient on standard office equipment including personal computer, multi-line telephone system, fax machine, copier, scanner.

Additional Information

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