Clinical Risk Manager

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $103.6k - $120k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🎲 Risk

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Ryan Specialty

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2010

💼 Consulting

🏗️ Construction

🏥 Healthcare

Consulting • Construction • Healthcare

Ryan Specialty is an international specialty insurance firm that provides innovative solutions for brokers, agents, and insurance carriers. The company offers a range of services including wholesale brokerage, binding authority, and underwriting management through highly specialized managing general underwriters. Ryan Specialty is a leader in the wholesale brokerage industry, providing expertise with local knowledge and national authority. The firm is committed to delivering distinct national specialty programs and bespoke alternative risk solutions, supporting its clients with comprehensive insurance services.

📋 Description

• Analyze medical and pharmacy claims, clinical records, treatment plans, and emerging therapies to identify high-cost claim exposure and stop loss risk • Evaluate current and future claim liabilities involving oncology, transplants, specialty pharmacy, gene and cell therapy, catastrophic claims, and chronic conditions • Assess clinical severity, treatment patterns, and emerging risks to support stop loss underwriting and risk management decisions • Develop clinical cost projections for high-dollar claimants and complex cases • Monitor ongoing claims and identify changes in risk exposure • Provide financial analyses and forecasting for underwriting, renewal, captive, and carrier decisions • Partner with brokers, carriers, TPAs, case management teams, specialty vendors, and employer groups on cost containment and risk reduction • Evaluate and recommend clinical and financial mitigation solutions • Collaborate with stakeholders to implement cost-management strategies • Support captive risk management initiatives through clinical reviews and risk assessments • Present complex clinical information to clients, brokers, captives, carrier partners, and executive leadership • Serve as a clinical resource during renewals, prospect evaluations, and risk management consultations • Work with consultants, producers, underwriting partners, TPAs, brokers, carriers, and specialty vendors • Foster strategic relationships and participate in multidisciplinary discussions • Maintain documentation of clinical analyses, cost projections, and mitigation recommendations • Prepare reports, presentations, and executive summaries • Monitor outcomes and effectiveness of mitigation strategies

🎯 Requirements

• Associate's or Bachelor's Degree in Nursing or a related healthcare field preferred • Minimum of 3 years of clinical nursing experience • Minimum of 2 years of stop loss captive risk management required • Experience evaluating complex and catastrophic claims strongly preferred • Active and unrestricted Registered Nurse (RN) license • Clinical expertise combined with financial analysis, strategic problem-solving, and collaborative relationship management

🏖️ Benefits

• Paid company holidays • Vacation days • Sick days • Personal days • Paid parental leave • Mental health services • Bonuses for full-time roles • Benefits for full-time roles • Reasonable accommodations for individuals with disabilities