Clinical Nurse Consultant (RNs)

PartnerRe; Maple Grove (MN); On-site; USD 76,000 - 120,000; Full time

Benefits offered by this job

401(k) retirement plan

Health, dental, vision insurance

Wellness programs

Educational assistance programs

On-site amenities

Employee Resource Groups

Referral Program

Job summary

PartnerRe is seeking a Pulse Clinical Consultant (RN) to serve as a clinical risk manager. You will educate clients, validate risk, and collaborate with underwriting, claims and sales to optimize clinical and financial outcomes.

The role requires current RN licensure, 5+ years of clinical nursing, and 1–3 years in stop loss or related managed care areas. CCM preferred; strong Microsoft tools skills are expected.

Qualifications

• Current, unrestricted Registered Nurse (RN) license.
• Bachelor’s degree preferred; Associate degree in Nursing (ADN) with equivalent clinical experience will be considered.
• 5+ clinical nursing experience required.
• 1-3 years of stop loss, health insurance, reinsurance, utilization management, case management, or related managed care experience preferred.
• Experience with catastrophic claims, transplant, oncology, specialty pharmacy, infusion therapy, or cell and gene therapy preferred.
• Certified Case Manager (CCM) preferred.

Responsibilities

• Serve as risk managers, educating, validating, collaborating and solving complex medical reimbursement issues.
• Identify and understand a client’s risk profile and educate on managing that risk with providers.
• Provide clinical expertise to underwriting and claims departments to assure insightful administration of PartnerRe Health’s products.
• Review high-cost claims, trigger reports, and 50% notices to identify catastrophic diagnoses and interventions.
• Collaborate with Underwriting, Claims, and Sales to provide clinical expertise and a seamless client experience.
• Identify cost containment strategies including transplant networks, specialty care, case management, and specialty pharmacy solutions.

Skills

Microsoft Excel

Microsoft Access

Microsoft Outlook

Microsoft Word

Education

Bachelor’s degree preferred; ADN with equivalent experience

Tools

RNA health IT systems

Job description

Company Description

PartnerRe is a leading, privately owned, multi-line global reinsurer with a reputation of financial stability and strength, and a commitment to rebuilding businesses and communities after risk events around the world.

Company Description

PartnerRe is a leading, privately owned, multi-line global reinsurer with a reputation of financial stability and strength, and a commitment to rebuilding businesses and communities after risk events around the world.

Our mission is to continue to be a financially stable and predictable business partner, supporting our clients with solutions tailored to their needs, delivering superior returns to our owner, providing rewarding opportunities for our people and making a positive contribution to society. To achieve this, we live by our values of Integrity, Performance, Collaboration, Straightforward Communication and Respect and Care.

Core to The PartnerRe Experience is our global nature. No matter where you sit in the company, you are part of something bigger. Our teams represent our truly international mindset, forging connections across office locations and all levels of the organization and building a network of mutual success. The result is a day-to-day experience that will allow you to:

Shape your own career

Grow in a supportive environment

Connect with a community of experts

Make an impact

View Home - PartnerRe Experience e-book to find out more about what it's like to work at PartnerRe.

We are always looking for bright, proactive individuals to join our team!

PartnerRe is an equal opportunities employer.

Please join our company LinkedIn Page for all updates on new positions that are coming live.

Competitive Benefits

At PartnerRe, we are committed to supporting the professional growth and well-being of our employees. In addition to a competitive salary, paid time off and eligibility for an annual incentive, we offer a comprehensive benefits package designed to support your physical and mental health, learning and development goals, and lifestyle needs. These include:

Our benefits package includes comprehensive health, dental, and vision insurance for our employees and their dependents. We also offer wellness programs to promote a balanced and healthy lifestyle.

Financial Security

Plan for your future with our competitive retirement savings plans, including a 401(k) retirement plan. Additionally, we provide life insurance and disability coverage to protect you and your loved ones.

Professional Development

We are committed to supporting your growth and development. Take advantage of our educational assistance programs for Accounting and Actuarial professionals and our comprehensive L&D offerings to expand your skills and achieve your professional goals.

Additional Perks

Enjoy a range of additional perks such as on-site amenities, social events, Employee Resource Groups, a robust Referral Program and more.

Compensation

Salary Range: $76 000 - 120 000

Bonus: 10% Target

PartnerRe Health

the global Health Division of PartnerRe, is an acknowledged leader in providing risk management solutions to accident and health markets. The PartnerRe team of experienced professionals develops innovative, client-specific solutions by thoroughly understanding our clients’ goals, market, risk tolerance and exposures. Using a suite of proven proprietary financial and analytical tools, an effective risk management program is designed with extensive support services.

Scope And Responsibilities

The PULSE Clinical Consultant role is to serve as risk managers, working closely with our clients internal stakeholders to educate, validate, collaborate and solve complex and costly medical reimbursement issues. As clinical experts, our clinical consultants are able to identify and understand a clients’ risk profile, educate on how to more effectively manage that risk and work with a variety of specialty service providers to generate optimal outcomes both clinically and financially. They provide clinical expertise to PartnerRe’s underwriting and claims departments to ensure insightful administration of PartnerRe Health’s products.

Job Duties

• Conduct clinical disclosure reviews with Underwriting to assess risk and support stop loss and reinsurance underwriting decisions.
• Review high-cost claims, trigger reports, and 50% notices to identify catastrophic diagnoses, emerging risks, and intervention opportunities.
• Complete clinical risk assessments using medical, claims, and financial information.
• Collaborate with Underwriting, Claims, and Sales team to provide clinical expertise and seamless client experience.
• Identify and recommend cost containment strategies, including transplant networks, specialty care, case management, and specialty pharmacy solutions.
• Analyze complex transplant, specialty drug, and cell and gene therapy cases to recommend optimal solutions.
• Serve as a clinical resource to clients, brokers, and other stakeholders regarding high-cost medical risks.
• Utilize internal software and documentation systems to analyze risk, document, track, prioritize, and manage cases.
• Monitor cases approaching or exceeding the reinsurance layer and communicate significant developments to key stakeholders.
• Maintain current knowledge of emerging treatments, specialty drugs, cell and gene therapies, and stop loss industry trends.

Qualifications

Computer Skills

• Must be proficient in Microsoft programs including but not limited to Excel, Access, Outlook and Word. Must be able to learn other software programs required by the department.

Education and/or Experience

• Current, unrestricted Registered Nurse (RN) license.
• Bachelor’s degree preferred; Associate degree in Nursing (ADN) with equivalent clinical experience will be considered.
• 5+ clinical nursing experience required.
• 1-3 years of stop loss, health insurance, reinsurance, utilization management, case management, or related managed care experience preferred.
• Experience with catastrophic claims, transplant, oncology, specialty pharmacy, infusion therapy, or cell and gene therapy preferred.
• Certified Case Manager (CCM) preferred.

Other Skills And Abilities

• Must have or be able to quickly acquire knowledge of departmental program structure (mission, goals and objectives), department policies and procedures.
• Must have a sound knowledge and ability in business correspondence and an ability to proofread for grammar, spelling and punctuation with a high degree of accuracy.
• Must be able to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rates, obtain ratios and percentages and to draw and interpret bar graphs.
• Must maintain professional and technical expertise through participation in continuing education as necessary.
• Ability to handle multiple interruptions and adjustments to priorities throughout the day.
• Ability to communicate effectively with diverse individuals and to calmly and efficiently handle situations ranging from routine to urgent.
• Excellent memory and organizational ability, in order to set priorities, organize workload, handle multiple responsibilities and meet deadlines.
• Proficient on standard office equipment including personal computer, multi-line telephone system, fax machine, copier, scanner.

Additional Information

PartnerRe provides a working environment in which diversity is valued, where all employees feel welcome, respected, and empowered to perform at their best. We invite you to learn more about D&I at PartnerRe.

Thank you,

PartnerRe Hiring Team