Registered Nurse Clinical Risk Consultant

A company is looking for a Senior Clinical Risk Consultant. Key Responsibilities Coordinate with management and teams to review medical claims for appropriateness and identify cost-saving opportunities Investigate and negotiate medical and prescription charges, suggesting care alternatives and identifying billing errors Review complex medical treatment plans for appropriateness and coverage, and create educational presentations for various audiences Required Qualifications Active Registered Nurse license 5+ years of clinical nursing experience Preferred experience in Stop Loss insurance or 3+ years in Medical in-depth case management Strong knowledge of current medical conditions and treatment plans, including organ transplantation and oncology Independent analytical thinking and decision-making skills

Mar 4, 2025 - 23:37

A company is looking for a Senior Clinical Risk Consultant. Key Responsibilities Coordinate with management and teams to review medical claims for appropriateness and identify cost-saving opportunities Investigate and negotiate medical and prescription charges, suggesting care alternatives and identifying billing errors Review complex medical treatment plans for appropriateness and coverage, and create educational presentations for various audiences Required Qualifications Active Registered Nurse license 5+ years of clinical nursing experience Preferred experience in Stop Loss insurance or 3+ years in Medical in-depth case management Strong knowledge of current medical conditions and treatment plans, including organ transplantation and oncology Independent analytical thinking and decision-making skills