State Licensed Clinical Risk Analyst

Job Summary

To support effective case management, the full-time State Licensed Clinical Risk Analyst will review transplant and neonate cases, implement cost containment measures, and participate in medical underwriting while working remotely.

Key Responsibilities

• Gather in-depth information from various sources to develop comprehensive case management plans
• Determine objectives and actions to meet claimant needs and review available benefits at the reinsurance level
• Educate internal staff and third-party administrators about Specialty Claims Unit services

Required Qualifications

• Registered Nurse with an Associate's degree in Nursing (ADN) or Bachelor's degree in Nursing (BSN)
• Strong medical knowledge, including ICD, CPT, medical terminology, COBRA, and HIPAA
• Ability to apply knowledge of principles, practices, and procedures in clinical settings
• Advanced organizational and analytical skills with the capacity to manage multiple tasks
• Familiarity with industry changes and legal updates relevant to the insurance sector