Note: The job is a remote job and is open to candidates in USA. Ryan Specialty Benefits is a rapidly growing organization focused on clinical risk management and stop loss cost containment. The Clinical Risk Manager serves as a strategic clinical consultant, analyzing complex claims, developing cost mitigation strategies, supporting underwriting and risk management decisions, and collaborating with brokers, carriers, TPAs, vendors, and employer health plans.
Responsibilities
- Analyze medical and pharmacy claims, clinical records, treatment plans, and emerging therapies to identify high-cost claim exposure and stop loss risk
- Evaluate current and future claim liabilities, including complex cases involving oncology, transplants, specialty pharmacy, gene and cell therapy, catastrophic claims, and chronic conditions
- Assess clinical severity, treatment patterns, and emerging risks to support stop loss underwriting and risk management decisions
- Develop accurate clinical cost projections for high-dollar claimants and complex cases
- Monitor significant ongoing claims and identify potential changes in risk exposure
- Provide detailed financial analyses and forecasting that support underwriting, renewal, captive, and carrier decision-making
- Partner with brokers, carriers, TPAs, case management teams, specialty vendors, and employer groups to identify opportunities for cost containment and risk reduction
- Evaluate and recommend clinical and financial mitigation solutions, including:
- Specialty pharmacy optimization
- Biosimilar conversion opportunities
- Site-of-care management
- Centers of Excellence utilization
- Case management intervention
- Transplant management programs
- Gene and cell therapy solutions
- Alternative funding and assistance programs
- Collaborate with internal and external stakeholders to implement effective cost-management strategies that improve outcomes while controlling plan spend
- Support captive risk management initiatives through ongoing clinical reviews and risk assessments
- Present complex clinical information in a concise, actionable manner for clients, brokers, captives, carrier partners, and executive leadership
- Serve as a trusted clinical resource during renewal discussions, prospect evaluations, and risk management consultations
- Work closely with Ryan Specialty Benefits consultants, producers, underwriting partners, TPAs, brokers, carriers, and specialty vendors
- Foster strong strategic relationships that support innovative client solutions and exceptional service delivery
- Participate in multidisciplinary discussions to identify trends, share best practices, and improve overall risk management outcomes
- Maintain accurate documentation of clinical analyses, cost projections, and mitigation recommendations
- Prepare reports, presentations, and executive summaries that communicate clinical risk and financial impact to diverse audiences
- Monitor outcomes and effectiveness of implemented mitigation strategies
Skills
- Minimum of 3 years of clinical nursing experience
- Minimum of 2 years of stop loss captive risk management required
- Active and unrestricted Registered Nurse (RN) license
- Associate's or Bachelor's Degree in Nursing or a related healthcare field preferred
- Experience evaluating complex and catastrophic claims strongly preferred
Benefits
- Paid time off for company holidays, vacation, sick and personal days
- Paid parental leave
- Mental health services
- Full-time roles are eligible for bonuses
Company Overview
Company H1B Sponsorship