Lead Medical Risk Consultant

Responsibilities Perform new business and renewal large claims reviews and disclosure assessments through clinical and claims data evaluation to identify and quantify risks. Provide concise, detailed, and accurate reporting of data analysis findings, observations, and recommendations. Serve as the subject matter expert for claims and underwriting related to risk management. Provide clinical assessment and recommendations for setting reserves on large dollar claims. Present in-house clinical education to enhance understanding of high-cost diagnoses and treatment trends. Responsible for clinical thought leadership, participating in product development and educational presentations. Consult with internal and external clients on high-cost, complex claims and engage in effective clinical risk management strategies. Review transplant contracts and vendor selections for quality control to ensure the best options. Build relationships with key stakeholders to communicate risk factors and develop recommendations for continuous improvement. Requirements Bachelor's Degree or equivalent combination of education and work experience Certifications as a Registered Nurse (RN) #J-18808-Ljbffr Jobtailor