Registered Nurse Risk Consultant

Job Summary

To enhance the Medical Risk Consultant team's effectiveness, the full-time Medical Risk Process Improvement & Training Consultant will develop and deliver training programs, oversee process improvements, and conduct medical risk assessments to support underwriting in evaluating potential risks associated with Stop Loss coverage.

Key responsibilities

• Develop and maintain a structured training framework for Medical Risk Consultants, focusing on onboarding and ongoing education
• Serve as the primary resource for assigned processes, identifying opportunities for quality and efficiency improvements within the MRC function
• Conduct medical risk reviews and provide clinical insights to support underwriting decisions related to high-cost medical conditions

Required qualifications

• Active Registered Nurse license with required continuing education hours
• 5-8 years of relevant clinical nursing experience
• Experience in training development and delivery, particularly in a remote setting
• Strong understanding of medical risk assessment methodologies and underwriting processes
• Project Management or Process Improvement certification is a plus