State Licensed Medical Risk Consultant

Job Summary

A company is looking for a Medical Risk Consultant - Remote.

Key Responsibilities

• Evaluate stop loss claimant details to assess potential medical risks for underwriting purposes
• Provide written assessments and advise on claims involving significant risk
• Collaborate with Third Party Administrators and maintain current claimant clinical status and cost containment activities

Required Qualifications

• Registered Nurse license required
• Associate's Degree required; Bachelor's degree preferred
• 3+ years of clinical nurse experience and 2+ years of case management experience preferred
• 2+ years' experience in healthcare or health insurance industry; stop loss or reinsurance preferred
• Case Manager Certification (CCM) and insurance industry education is a plus