Registered Nurse, Stop Loss Cost Containment - Berkley

Company Details:

 

Berkley Accident and Health is a risk management company that designs innovative solutions to address the unique challenges of each client. With our entrepreneurial culture and a strong emphasis on analytics, we can help employers better manage their risk. We offer a broad range of products, including employer stop loss, benefit captives, provider stop loss, HMO reinsurance, and specialty accident. The key to Berkley’s success is our nimble approach to risk – our ability to quickly understand, think through, and devise a plan that addresses each client’s challenges, coupled with the strong backing of a Fortune 500 company. Our parent company, W. R. Berkley Corporation, is one of the largest and best managed property/casualty insurers in the United States.

 

The company is an equal employment opportunity employer.

Responsibilities:

We have an opportunity for a Registered Nurse, Stop Loss/Clinical Cost Containment to join our  Berkley Accident and Health team!  Reporting to our AVP Health Risk Management, you will utilize your knowledge and experience in a unique and rewarding manner.  Our Clinical Cost Containment (CCC) RNs provide consulting services for internal and external clients and their delegated entities.  You will promote a thorough understanding of current and anticipated clinical needs and expected claim costs while facilitating the use of unique solutions to insure optimal care and claims outcomes. 

 

This position can be based remote, anywhere in the U.S.

 

We have a welcoming culture valuing our employees – we trademarked the phrase Everything Counts, Everyone Matters® to describe the Berkley commitment to our people and how we do business. We believe that every person in the organization is important and every accomplishment makes a difference in our results. Come join us!   

 

Key functions include but are not limited to:

• Identify and present future or impending diagnosis of concern with ability to develop, determine, and recommended clinical risk mitigation course of action for both Berkley Accident and Health and our clients
• Responsible for the independent review of TPA trigger reports, claim referrals or similar information identifying potential catastrophic diagnoses or cases of concerns regarding potential cost savings opportunities
• Collaborate with our Claims department to obtain updated/additional clinical or financial information from the client (TPA, Policyholder, Broker)
• Support Cost Containment department through creation of educational clinical risk management material, meetings & presentations for both internal (Sales, Claims, UW, Program/CR management, etc.)
• Provide clinical data analytics and benchmarking
• Identify and present future or impending diagnosis of concern with ability to develop, determine, and recommended clinical risk mitigation course of action for both Berkley Accident and Health BAH and our clients
• Initiate and collaborate with Cost Containment vendors in support of Policyholder optimal outcomes
• Serve as subject matter reference for our company’s cost containment programs, including but not limited to our interaction with TPAs, Claims, Sales, Underwriters, Client Representatives, and Brokers
• Serve as a subject matter reference in analysis of transplant contracts and provide guidance to the TPA/Case Managers in the selection of the best transplant contract for their client
• Responsible for independently understanding the nuances of each line of business and adjust activities and interventions based on the uniqueness of each market segment
• Other duties as may be assigned

Qualifications:

• BA/BS in Nursing or related field
• Preferred to have the following certification: Certification in Case Management (CCM)
• 5+ years of group medical, managed care, first dollar health insurance, stop loss or reinsurance experience
• Able to set goals and handle multiple tasks, clients and projects simultaneously; able to appropriately balance priorities, deadlines and deliverables;  able to quickly adapt to change, work under tight deadlines
• Proficient level of the following skill sets:  investigative, analytical, negotiating, persuasion, conflict resolution, critical thinking and problem-solving skills
• Must have excellent oral, written and interpersonal communication skills
• Strong knowledge of Medical Coding
• Ability to professionally represent and present BAH with small group presentation skills
• Demonstrated mathematical skills and PC skills
• Solid negotiation skills, confidentiality, discretion, and tact 
• Ability to travel 5-10%

Additional Company Details:We do not accept any unsolicited resumes from external recruiting firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees including:• Base Salary Range: $120,000 - $140,000 • Eligible to participate in annual discretionary bonus • Benefits include: Health, dental, vision, dental, life, disability, wellness, paid time off, 401(k) and profit-sharing plansThe actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.Sponsorship Details:Sponsorship not Offered for this RoleJob Description:

CCC RN Consultant