This job was posted by https://idahoworks.gov : For more information,please see: https://idahoworks.gov/jobs/2153918 Medical RiskConsultant

　　Work Remotely in the United State

　　Primary Job Purpose

　　The Medical Risk Consultant collaborates with underwriters toproactively evaluate and price potential ongoing risks that will affectthe loss ratio of a stop loss group. This position provides medicalinput on claim payment interpretations.

　　General Functions and Outcomes

　　Assists the underwriting team in evaluating and pricing the risk ofpotential large claimants for all new groups and renewals.Reviews the costs associated with the risk and have a workingknowledge of costs in the Blue Environment.Develop processes for risk analysis in coordination withunderwriting.Assists with tracking of risk on high cost claimants.Assumes responsibility for maintaining clinical competency, forexample attending pertinent medical conferences, workshops, andseminars relating to current medical practices, procedures andhealthcare industry on at least an annual basics.Assumes accountability for the monitoring, quality assurance, ortraining of new staff, as assigned.Shares knowledge with colleagues that will enhance the performanceof job functions.Provides input on medical interpretations and the setting of claimreserves.Assists with TPA/broker or other external visits.Minimum Requirements

　　Demonstrated competency to work in conjunction with the underwritersto come up with creative risk solutions.Demonstrated knowledge of medical technology and the related cost.Extensive knowledge of facility inpatient and outpatient codingand/or claim review, facility and benefit contracts, language andimplications.Advanced knowledge of medical and surgical procedures and otherhealthcare practices required.Demonstrated understanding of standard office and business practicesand desktop applications; excellent computer skills and proficiencyworking software programs (e.g., Microsoft Word and Excel, Outlook,and database query tools).Able to function efficiently in multiple claim systems.Demonstrated math aptitude, analytical ability, competent inperforming complex and detailed work with high level of accuracy andindependently without direct supervision.Strong communication skills; clear and succinct, both orally and inwriting, with peers and colleagues, regarding complex and sensitiveissues.Experience leading complex internal projects and initiativesimpacting business operations and product decision making.Demonstrated research and documentation skills.Advanced knowledge of health plan cost containment strategiesincluding medical management interventions, provider contractingmethodologies, and benefit design alternatives.Demonstrated competency in analyzing cost of care based on highlyindividualized data.Demonstrated competency to interpret risk with varying factors thatare individual and group specific.Strong knowledge of case management functions and the ability to bea resource to that team.Normally to be proficient in the competencies listed above

　　The Medical Risk Consultant would have an Associate\'s or Bachelor\'sdegree in health-related field and a current RN License with 5 years ofexperience in the health insurance or healthcare field in addition to 3years of clinical experience.

　　Required Licenses, Certifications, Registration, Etc.

　　RN

　　Work Environment

　　No unusual working conditions.

　　The expected hiring range for a Medical Risk Consultant is\$109,700.00 - \$148,400.00 depending on skills, experience, education,and training; relevant licensure / certifications; performance history;and work locatio . The bonus target for this position is 18.75%. Thecurrent full salary range for this role is \$103,000.00 to \$168,000.00.

　　#LI-remote

　　Base pay is just part of the compensation package at Cambia that issupplemented with an exceptional 401(k) match, bonus opportunity andother benefits. In keeping with our Cause and vision, we offercomprehensive well-being programs and benefits, which we periodicallyupdate to stay current. Some highlights:

　　medical, dental, and vision coverage for employees and their eligiblefamily members

　　annual employer contribution to a health savings account (\$1,200 or\$2,500 depending on medical coverage, prorated based on hire date)

　　paid time off varying by role and tenure in addition to 10 companyholidays

　　up to a 6% company match on employee 401k contributions, with apotential discretionary contribution based on company performance (novesting period)

　　up to 12 weeks of paid parental time off (eligible day one of employmentif within first 12 months following birth or adoption)

　　one-time furniture and equipment allowance for emp