New Jersey Licensed Clinical Risk Manager

Job Summary

A company is looking for a Clinical Risk Manager, Cost Containment, to work remotely.

Key Responsibilities

• Support the development and implementation of clinical risk management strategies for high-cost claims
• Act as a strategic partner to underwriting by evaluating complex clinical and claims data
• Develop and manage relationships with clients, TPAs, and vendors while ensuring data integrity and compliance

Required Qualifications

• 6-10 years of clinical experience with current unrestricted licensure as a health professional (Registered Nurse)
• 6+ years of reinsurance or insurance industry experience required
• Bachelor's degree from an accredited university or equivalent experience required
• Strong PC skills including Excel, Word, and Outlook
• Experience in group medical, managed care, health insurance, stop loss, or reinsurance required