Medical Risk Consultant, RN

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Virtue Health

WebsiteLinkedInAll Job Openings

11 - 50 employees

Founded 2016

⚕️ Healthcare Insurance

💳 Fintech

Healthcare Insurance • Insurance • Fintech

Virtue Health is a private group stop-loss purchasing consortium that helps small to midsize employers share risk, lower volatility, and improve benefits in their healthcare plans. By utilizing a pooled risk model, Virtue Health enables its members to spend on healthcare at 40% less than the national average, while providing predictable long-term risk financing strategies for stop-loss insurance. The consortium emphasizes a selective membership, ensuring all employers are focused on controlling costs and enhancing employee benefits.

📋 Description

• Review stop-loss claim notices and claimant medical records to identify high-cost trajectories before excess loss is incurred • Produce written clinical assessments that translate prognosis and treatment trajectory into actionable underwriting guidance • Advocate directly with stop-loss carrier partners for laser reduction or removal at renewal • Deliver clinical education to internal staff, TPA partners, and the adviser network on high-cost diagnoses

🎯 Requirements

• 5+ years of direct clinical nursing experience in an acute care setting such as ICU, oncology, transplant, surgical, or complex chronic disease management • Active, unencumbered RN license; compact state license strongly preferred given the remote and multi-state nature of the work • 3+ years of case management, utilization review, or payer-side experience at a TPA, HMO, PPO, stop-loss carrier, or reinsurance firm • Working knowledge of how stop-loss insurance, self-funded health plans, and TPA operations work • CCM (Certified Case Manager) certification

🏖️ Benefits

• Performance bonus: up to 10% of base tied to measurable cost containment outcomes (MBO) • Health and Dental insurance • Life, short-term and long-term disability insurance • 401(k) • PTO • Travel: Up to 10% for consortium events, TPA partner visits, and industry conferences