Clinical Risk Manager - Insurance Company
Seeking licensed nurse with clinical experience to evaluate potential risk and project expected claim costs based on ICD 9 / ICD 10 codes, current treatment plan, and other pertinent medical information.
*** Review and assess large claim reports, shock claim summary reports, trigger reports, and large case management notes for medical conditions and respond with a cost analysis.
*** Utilize reputable clinical resources such as Predict Dx, NCCN, NORD, and CDC.
*** Identify high riskassociated with individuals and communicate required stop loss cost analyzation of current clinical conditions and ongoing cost projections.
*** Complete cost projections on new and renewal business within 24-48 hours of receipt.
*** Document clinical summary and estimated cost of care for each individual identified as at risk.
Fast paced and growth oriented organization offers a competitive compensation package, comprehensive health care plan, bonuses, 401(k) with company match, generous vacation time, numerous professional development opportunities, and more!
Education Requirements: Bachelor Degree
Minimum Experience Requirements: 5-10 years
Job City Location: Boston
Job State Location: MA
Job Country Location: USA
DISCLAIMER: We will make every effort to consider applications for all available positions and shall use one or more of the contact methods and addresses indicated in resume or online application. Indicated location may be proximate or may be desirable point of embarkation for paid or unpaid relocation to another venue. Job descriptions may fit single or multiple presently available or anticipated positions and are NOT an offer of employment or contract implied or otherwise. Described compensation is not definite nor precise and may be estimated and approximate and is negotiable depending on market conditions and candidate availability and other factors and is solely at the discretion of employers. Linguistics used herein may use First Person Singular and First Person Plural grammatical person construction for and with the meaning of Third Person Singular and Third Person Plural references. We reserves the right to amend and change responsibilities to meet business and organizational needs as necessary. Response to a specific posting or advertisement may result in consideration for other opportunities and not necessarily the incentive or basis of the response. Nothing herein is or may be considered a promise, guarantee, offer, pledge, agreement, contract, or oath.