Clinical Risk & Reimbursement Nurse Consultant

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

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.