Registered Nurse Clinical Risk Consultant

Company: VirtualVocations
Location: Toms River
Posted on: March 7, 2025

Job Description:

A company is looking for a Senior Clinical Risk Consultant.
Key Responsibilities

Coordinate with management and teams to review medical claims for appropriateness and identify cost-saving opportunities
Investigate and negotiate medical and prescription charges, suggesting care alternatives and identifying billing errors
Review complex medical treatment plans for appropriateness and coverage, and create educational presentations for various audiences

Required Qualifications

Active Registered Nurse license
5+ years of clinical nursing experience
Preferred experience in Stop Loss insurance or 3+ years in Medical in-depth case management
Strong knowledge of current medical conditions and treatment plans, including organ transplantation and oncology
Independent analytical thinking and decision-making skills

Keywords: VirtualVocations, Toms River , Registered Nurse Clinical Risk Consultant, Healthcare , Toms River, New Jersey

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