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Nurse(RN) Clinical Risk Manager job in Media

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J R Peterman Associates, Inc. jobs
Career Interest:  Claims
Insurance Discipline:  Managed Care
Life and Health
Job Type:  Full Time
State:  Pennsylvania (PA)
City:  Media
Post Code:  05672
Media, PA 19063, USA (Show on map)

If you are a nurse who is interested in moving from hospital patient care to advising health insurance claims and underwriting staff on prognosis of serious illness/injury, this position is worth a look.

The Clinical Risk Manager (CRM) is responsible for researching, educating, and assisting Underwriters and Claims staff in evaluating potential medical treatment cost of individuals identified in new and renewal business underwriting process to provide estimated claim risk for current and upcoming policy periods.

CRM will be a resource to the Policyholder's Third Party Administrator and Case Management Vendor with care and cost management oversight of potential stop loss claimants.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily with or without reasonable accommodation.

Review policyholder data to identify claimants with catastrophic care needs and assess medical & claims information available to calculate potential risk.

Provide written claimant assessments/reports within established deadlines to the Underwriters to utilize when establishing rates for new and renewal business.


Ability to use varying resources to research diagnoses, treatments and average costs
Strong computer proficiency (MS Word, Outlook, Excel, PowerPoint, David Young, Predictex)
Ability to work independently and in team environment
Registered Nurse
Four or more years nurse clinical experience in Hospital
Maintain CE hours for State RN Licensure

Salary:  Open
Bonus/Benefits:  $65-85K

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