1341 clinical risk manager jobs found

Crum & Forster Company Overview Crum & Forster (C&F) , with a proud history dating to 1822, provides specialty and standard commercial lines insurance products through our admitted and surplus lines insurance companies. C&F enjoys a financial strength rating of "A" (Excellent) by AM Best and is proud of our superior customer service platform. Our claims and risk engineering services are recognized as among the best in the industry. Our most valuable asset is our people: more than 2500 employees in locations throughout the United States. The company is increasingly winning recognition as a great place to work, earning several workplace and wellness awards for four years running, including the 2025 Great Place to Work® Award for our employee-first focus and our steadfast commitment to diversity, equity and Inclusion. C&F is part of Fairfax Financial Holdings, a global, billion dollar organization.  For more information about...

Position Summary We are seeking a highly skilled and experienced stop loss Clinical Risk Manager to join our team. The ideal candidate will have a strong clinical background and expertise in evaluating and managing stop loss claims. This role involves analyzing clinical data, assessing potential risks, and providing cost projections to support our underwriting and risk management processes. What will your job entail? Key Responsibilities: Clinical Data Analysis: Review and analyze clinical data to assess potential stop loss claim liabilities. Cost Projections: Provide cost projections on high-dollar claimants to support underwriting decisions. Case Management Oversight: Utilize case management techniques to ensure effective cost containment and management of high-risk claims. Collaboration: Work closely with Third Party Administrators (TPAs), case managers, and internal teams to ensure effective communication and management of clinical information....

Company: Marsh McLennan Agency Description: Peak Health  is a subsidiary of one of the nation’s largest insurance brokers, McGriff, that employs clinically-based lifestyle and behavior change programs led by registered nurses who provide health risk assessments, help employees navigate wellness offerings, and drive individual accountability of health through personalized coaching to help employers get control over their healthcare costs. Peak Health is a recognized behavioral change and nurse coaching leader in the industry. Our company was founded in 1989 by two nurse practitioners who wanted to improve employee health behaviors. With over 35 years of results and impact, touching the lives of 100,000+ participants with clinical programming, check out this case study that highlights our proven results to understand why we do what we do! Peak Health is seeking Traveling Health & Wellness Nurse Coach in Charlotte, NC Work Schedule:  32 hours/4 days per week...

We’re thrilled that you are interested in joining us here at the Amynta Group! This position is responsible for producing consistently accurate and timely rates for customers with a vast range in complexity. Specialists support the evaluation and selection of risk and the establishment of premium levels which ensure profitable acquisition of new cases and/or the continued profitable retention of in-force cases. Primary accountability is to determine the proper plan design and census manipulation needed to build the appropriate rate. The quality, accuracy, and reasonableness of the rate serves as the foundation for accurate risk assessment and ultimate pricing decisions that follow. This role requires a strong partnership with Underwriters, peers, and other partners to ensure all data needs are met, work hand-offs are effectively communicated, and due dates are managed. Principal Duties and Responsibilities Manage the quote process for quote requests by evaluating and...

The Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care.  Clinical and/or technical expertise is utilized to address the provision of medical care and to identify inappropriate billing practices and errors inclusive of, but not limited to; duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time increment discrepancies, inconsistencies with  diagnosis, treatment frequency and duration of care, DRG validation, service/treatment vs. scope of discipline, use of appropriate billing protocols, etc.  This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify the necessity of the review process and communicate any specific issues...

CorVel Corporation is hiring a caring, self-motivated, energetic and independent registered nurse to fill a Field Case Manager position in the Fairfax, Alexandira Area.  Work from home, and on the road. Monday – Friday, regular business hours.   As a Field Case Manager you will make a meaningful difference in the lives of injured workers and their families.  Your responsibilities include working closely with injured workers to facilitate their recovery. You will work collaboratively with the patient, their family, medical providers, members of our team, and others.  This is a heavy local travel role responsible for working with a caseload of workers compensation injured workers within a defined jurisdiction.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provides Medical Case Management to individuals through in person and telephonic communications with the patient, physician, other health care providers, employer and others. Utilizes their medical and nursing...

CorVel Corporation is hiring a caring, self-motivated, energetic and independent registered nurse to fill a Medical Case Manager position.   Work from home, and on the road. Monday – Friday, regular business hours.   As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and their families.  Your responsibilities include working closely with injured workers to facilitate their recovery. You will work collaboratively with the patient, their family, medical providers, members of our team, and others.  This is a heavy local travel role responsible for working with a caseload of workers compensation injured workers within a defined jurisdiction.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provides Medical Case Management to individuals through in person and telephonic communications with the patient, physician, other health care providers, employer and others. Utilizes their medical and nursing knowledge to discuss the current...

The Case Management Supervisor is responsible for directing the operations of their designated department, which may include one or more of the following functions: human resources, customer service, and limited sales management. This is a remote role reporting to the Des Moines, IA office but candidate must be able to travel throughout NE, KS, MO, and IA. ESSENTIAL FUNCTIONS &RESPONSIBILITIES: Responsible for directing a designated group of employees in their day-to-day operations Responsible for quality of service provided Responsible for human resources matters directly related to department supervised Requires regular and consistent attendance Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP) May be required to travel overnight and attend meetings May perform daily, weekly, monthly reviews of various reports, invoices, logs and expenses May be responsible for limited...

CorVel Corporation is hiring a caring, self-motivated, energetic and independent registered nurse to fill a Medical Case Management Nurse position in Louisiana.   Work from home, and on the road. Monday – Friday, regular business hours.   As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and their families.  Your responsibilities include working closely with injured workers to facilitate their recovery. You will work collaboratively with the patient, their family, medical providers, members of our team, and others.  This is a heavy local travel role responsible for working with a caseload of workers compensation injured workers within a defined jurisdiction.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provides Medical Case Management to individuals through in person and telephonic communications with the patient, physician, other health care providers, employer and others. Utilizes their medical and nursing knowledge...

Company: Marsh McLennan Agency Description: Peak Health   is a subsidiary of one of the nation’s largest insurance brokers, McGriff, that employs clinically-based lifestyle and behavior change programs led by registered nurses who provide health risk assessments, help employees navigate wellness offerings, and drive individual accountability of health through personalized coaching to help employers get control over their healthcare costs. Peak Health is a recognized behavioral change and nurse coaching leader in the industry. Our company was founded in 1989 by two nurse practitioners who wanted to improve employee health behaviors. With over 35 years of results and impact, touching the lives of 100,000+ participants with clinical programming, check out this case study that highlights our proven results to understand why we do what we do! Peak Health is seeking Traveling Health & Wellness Nurse Coach to cover the following locations: 1. Raleigh 2. Cary 3....

Company: Marsh McLennan Agency Description: Peak Health is seeking Customer Service Representative in Wilson, NC Peak Health  is a subsidiary of one of the nation’s largest insurance brokers, McGriff, that employs clinically-based lifestyle and behavior change programs led by registered nurses who provide health risk assessments, help employees navigate wellness offerings, and drive individual accountability of health through personalized coaching to help employers get control over their healthcare costs. Peak Health is a recognized behavioral change and nurse coaching leader in the industry. Our company was founded in 1989 by two nurse practitioners who wanted to improve employee health behaviors. With over 35 years of results and impact, touching the lives of 100,000+ participants with clinical programming, check out this case study that highlights our proven results to understand why we do what we do! ADDITIONAL INFORMATION (all positions):  **Company...

CorVel Corporation is hiring a caring, self-motivated, energetic and independent registered nurse to fill a Medical Case Manager position in Charlotte, NC.   Work from home, and on the road. Monday – Friday, regular business hours. As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and their families.  Your responsibilities include working closely with injured workers to facilitate their recovery. You will work collaboratively with the patient, their family, medical providers, members of our team, and others.  This is a heavy local travel role responsible for working with a caseload of workers compensation injured workers within a defined jurisdiction.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provides Medical Case Management to individuals through in person and telephonic communications with the patient, physician, other health care providers, employer and others. Utilizes their medical and nursing knowledge to...

The Telephonic Case Manager coordinates resources and creates flexible, cost-effective options for ill or injured individuals on a case-by-case basis to facilitate quality individualized treatment goals, including timely return-to-work if appropriate. The Telephonic Case Manager will rely on their medical knowledge to evaluate the patient’s current treatment plan for medical appropriateness based on their physical and medical status. The Telephonic Case Manager must be able to discuss the patient’s medical and physical conditions with the treating physicians, along with discussing/ recommending alternate treatment plans for the patient. The Telephonic Case Manager must have the ability to explain medical conditions and treatment plans to the patient, family members and adjuster; supporting the goals of the Case Management department, and of CorVel.   ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Provides medical case management to individuals through coordination with the...

CorVel Corporation is hiring a caring, self-motivated, energetic and independent registered nurse to fill a Medical Case Manager position in the Huntsville, AL area.   Work from home, and on the road. Monday – Friday, regular business hours.   As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and their families.  Your responsibilities include working closely with injured workers to facilitate their recovery. You will work collaboratively with the patient, their family, medical providers, members of our team, and others.  This is a heavy local travel role responsible for working with a caseload of workers compensation injured workers within a defined jurisdiction. This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provides Medical Case Management to individuals through in person and telephonic communications with the patient, physician, other health care providers, employer and others. Utilizes their...

CorVel Corporation is hiring a caring, self-motivated, energetic and independent registered nurse to fill a Medical Case Manager position in Lake Mary, FL.   Work from home, and on the road.  As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and their families.  Your responsibilities include working closely with injured workers to facilitate their recovery. You will work collaboratively with the patient, their family, medical providers, members of our team, and others.  This is a heavy local travel role responsible for working with a caseload of workers compensation injured workers within a defined jurisdiction.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provides Medical Case Management to individuals through in person and telephonic communications with the patient, physician, other health care providers, employer and others. Utilizes their medical and nursing knowledge to discuss the current treatment plan with the...

CorVel Corporation is hiring a caring, self-motivated, energetic and independent registered nurse to fill a Medical Case Manager position in Brunswick, GA.   Work from home, and on the road. Monday – Friday, regular business hours.   As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and their families.  Your responsibilities include working closely with injured workers to facilitate their recovery. You will work collaboratively with the patient, their family, medical providers, members of our team, and others.  This is a heavy local travel role responsible for working with a caseload of workers compensation injured workers within a defined jurisdiction. This is a part time position.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provides Medical Case Management to individuals through in person and telephonic communications with the patient, physician, other health care providers, employer and others. Utilizes their...

  The Telephonic Case Manager coordinates resources and creates flexible, cost-effective options for ill or injured individuals on a case-by-case basis to facilitate quality individualized treatment goals, including timely return-to-work if appropriate. The Telephonic Case Manager will rely on their medical knowledge to evaluate the patient’s current treatment plan for medical appropriateness based on their physical and medical status. The Telephonic Case Manager must be able to discuss the patient’s medical and physical conditions with the treating physicians, along with discussing/ recommending alternate treatment plans for the patient. The Telephonic Case Manager must have the ability to explain medical conditions and treatment plans to the patient, family members and adjuster; supporting the goals of the Case Management department, and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Provides medical case management to individuals...

The Telephonic Case Manager coordinates resources and creates flexible, cost-effective options for ill or injured individuals on a case-by-case basis to facilitate quality individualized treatment goals, including timely return-to-work if appropriate. The Telephonic Case Manager will rely on their medical knowledge to evaluate the patient’s current treatment plan for medical appropriateness based on their physical and medical status. The Telephonic Case Manager must be able to discuss the patient’s medical and physical conditions with the treating physicians, along with discussing/ recommending alternate treatment plans for the patient. The Telephonic Case Manager must have the ability to explain medical conditions and treatment plans to the patient, family members and adjuster; supporting the goals of the Case Management department, and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Provides medical case management to individuals through...

Porch Group is a leading vertical software and insurance platform and is positioned to be the best partner to help homebuyers move, maintain, and fully protect their homes. We offer differentiated products and services, with homeowners insurance at the center of this relationship. We differentiate and look to win in the massive and growing homeowners insurance opportunity by 1) providing the best services for homebuyers, 2) led by advantaged underwriting in insurance, 3) to protect the whole home. As a leader in the home services software-as-a-service (“SaaS”) space, we’ve built deep relationships with approximately 30 thousand companies that are key to the...

The Diagnostic Related Groups (DRG) Clinical Auditor will be responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation to determine correct DRG/coding and clinically supported as defined by review methodologies specific to the type of review. This involves completing medical records review, accurately documenting findings and non-findings and providing clinical/policy/regulatory support for the determination. Experience using ICD-10-CM & PCS coding guidelines, the ability to understand modern pharmacology, disease management and clinical intervention procedures.  The ideal DRG Clinical Auditor candidate will have strong oral and written communication skills, clinical knowledge of disease process, and knowledge of medical necessity rules. This is a remote position.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: The Clinical Auditor will review medical records to determine accuracy of billing through...