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Virtue Health

Meet Virtue Health Alliance, a private group stop loss purchasing consortium that allows employers to share risk.

Medical Risk Consultant, RN

RiskRiskFull TimeRemoteSeniorTeam 11-50Since 2016H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

3 days ago

Salary

0

Seniority

Senior

Bachelor Degree5 yrs expEnglish

Job Description

Medical Risk Consultant, RN

Virtue Health

• Review stop-loss claim notices and claimant medical records to identify high-cost trajectories before excess loss is incurred • Produce written clinical assessments that translate prognosis and treatment trajectory into actionable underwriting guidance • Advocate directly with stop-loss carrier partners for laser reduction or removal at renewal • Deliver clinical education to internal staff, TPA partners, and the adviser network on high-cost diagnoses

Job Requirements

  • 5+ years of direct clinical nursing experience in an acute care setting such as ICU, oncology, transplant, surgical, or complex chronic disease management
  • Active, unencumbered RN license; compact state license strongly preferred given the remote and multi-state nature of the work
  • 3+ years of case management, utilization review, or payer-side experience at a TPA, HMO, PPO, stop-loss carrier, or reinsurance firm
  • Working knowledge of how stop-loss insurance, self-funded health plans, and TPA operations work
  • CCM (Certified Case Manager) certification

Benefits

  • Performance bonus: up to 10% of base tied to measurable cost containment outcomes (MBO)
  • Health and Dental insurance
  • Life, short-term and long-term disability insurance
  • 401(k)
  • PTO
  • Travel: Up to 10% for consortium events, TPA partner visits, and industry conferences

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