California Licensed Clinical Risk Consultant

Job Summary

A company is looking for a Senior Clinical Risk Consultant to provide clinical expertise and support for underwriting processes.

Key Responsibilities

• Conduct clinical risk assessments by reviewing medical records and identifying high-risk cases
• Develop cost projections and evaluate treatment pathways for high-cost claimants
• Collaborate with underwriters to provide insights on risk selection and pricing strategies

Required Qualifications

• Active Registered Nurse (RN) license required; Bachelor of Science in Nursing (BSN) preferred
• 5+ years of clinical experience in areas such as ICU, oncology, or case management
• Experience in stop loss, health insurance, or underwriting support is strongly preferred
• Proficiency in Microsoft Office and familiarity with clinical review tools
• Knowledge of medical cost drivers and treatment protocols related to high-cost conditions