Clinical Risk Manager

We have an excellent opportunity for an experienced Clinical Risk Nurse Consultant to join our team in Swiss Re's Accident & Health division!

About the Role

This position requires a strong clinical background in disease state management/case management experience.  A background in a Clinical Risk Management position is encouraged but will consider qualified candidates especially those with an oncology or cardiology background.  This position is ideal for applicants looking to enter the insurance sector in a nurse consultant role.

In this position you have the responsibility to use your knowledge and experience to project expected treatment costs based on ICD 9 / ICD 10 codes, current treatment plan and other pertinent medical information.

Principal responsibilities include:

• Review medical conditions and respond with a cost analysis coordinated to the Stop Loss case characteristics. Including the review and assessment of large claim reports, shock claim summary reports, trigger reports and large case management notes.
• Identify high risk associated with individuals and communicate required stop loss cost analyzation of current clinical conditions and future cost projections.
• Utilize provided clinical resources such as Predict Dx, NCCN, NORD, and CDC.
• Supply and manage documentation with clinical summary and estimated cost of services for each individual identified as at risk.

About the Team

 The Clinical Risk team brings value to Swiss Re working in close collaboration with Underwriters to determine and evaluate potential risk and associated costs of projected treatments and care.  We are a welcoming team of nurses who are passionate about what they do.  Diversity, Equity, and Inclusion are a part of our winning culture.  We believe that our individual performances contribute to the success of the team.  Come join us and be a part of something big!

About You

You bring your strong analytical and problem-solving expertise!  Your excellent interpersonal skills enable you to successfully navigate cross-functional collaboration.  You have an ability to prioritize well and work independently with little direct supervision, while handling numerous projects at once.

Additional requirements include:

• Minimum of Associate or Bachelor's degree in nursing with at least 1 year of Stop Loss Nursing experience
• Must have up to date registered nurse (RN) license
• Able to demonstrate a track record of producing work that is highly accurate, shows attention to detail, and reflects well on the organization
• Excellent written and verbal communication skills
• Computer proficiency, specifically strong typing skills and Internet research skills, must have a clear understanding of Microsoft Word, Microsoft Office and Excel.