Clinical Risk Manager

Position Summary

We are seeking a highly skilled and experienced stop loss Clinical Risk Manager to join our team. The ideal candidate will have a strong clinical background and expertise in evaluating and managing stop loss claims. This role involves analyzing clinical data, assessing potential risks, and providing cost projections to support our underwriting and risk management processes.

What will your job entail?

Key Responsibilities:

• Clinical Data Analysis: Review and analyze clinical data to assess potential stop loss claim liabilities.
• Cost Projections: Provide cost projections on high-dollar claimants to support underwriting decisions.
• Case Management Oversight: Utilize case management techniques to ensure effective cost containment and management of high-risk claims.
• Collaboration: Work closely with Third Party Administrators (TPAs), case managers, and internal teams to ensure effective communication and management of clinical information.
• Documentation: Maintain accurate and detailed documentation of clinical assessments, cost projections, and case management activities.
• Risk Assessment: Identify high-risk individuals and communicate required stop loss cost analysis based on current clinical conditions and future cost projections.
• Reporting: Prepare and present reports on clinical risk assessments and cost projections to senior management.

Qualifications:

• Education: Associate or Bachelor's degree in Nursing or a related field is preferred.
• Experience: At least 3 years of clinical experience, with a minimum of 1 year in stop loss nursing or clinical risk management.
• Licensure: Current and valid Registered Nurse (RN) license.
• Skills:
  • Strong analytical and problem-solving skills.
  • Excellent written and verbal communication skills.
  • Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint).
  • Ability to work independently and manage multiple projects simultaneously.
• Preferred: Experience in oncology or cardiology is a plus.

Working Conditions:

• Location: Portland Maine, in office or remote work.

Ryan Specialty is an Equal Opportunity Employer. We are committed to building and sustaining a diverse workforce throughout the organization. Our vision is an inclusive and equitable workplace where all employees are valued for and evaluated on their performance and contributions. Differences in race, creed, color, religious beliefs, physical or mental capabilities, gender identity or expression, sexual orientation, and many other characteristics bring together varied perspectives and add value to the service we provide our clients, trading partners, and communities. This policy extends to all aspects of our employment practices, including but not limited to, recruiting, hiring, discipline, firing, promoting, transferring, compensation, benefits, training, leaves of absence, and other terms, conditions, and benefits of employment.

How We Support Our Teammates 

Ryan Specialty seeks to offer our employees a comprehensive and best-in-class benefits package that helps them — and their family members — achieve their physical, financial, and emotional well-being goals. In addition to paid time off for company holidays, vacation, sick and personal days, Ryan offers paid parental leave, mental health services and more.

The target salary range for this position is $104,000.00 - $130,000.00 annually.

The wage range for this role considers many factors, such as training, transferable skills, work experience, licensure and certification, business needs, and market demands. The pay range is subject to change and may be modified in the future. Full-time roles are eligible for bonuses and benefits. For additional information on Ryan Specialty Total Rewards, visit our website https://benefits.ryansg.com/. 

 

We provide individuals with disabilities reasonable accommodations to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment in accordance with applicable law. Please contact us to request an accommodation at HR@Ryansg.com 

 

The above is intended to describe this job's general requirements. It is not to be construed as an exhaustive statement of duties, responsibilities, or physical requirements. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. 

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