Medical Risk Consultant, RN

Virtue Health

Clinical Risk Consultant at Virtue Health assessing high-cost claims and guiding stop-loss decisions. Collaborating with underwriters and delivering clinical education to optimize financial outcomes.

Posted 7/7/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive clinical nursing experience in acute care settings, with a strong focus on case management and utilization review. Proficient in translating clinical assessments into actionable underwriting guidance and advocating for stop-loss insurance solutions.

Highest-signal resume keywords

Clinical Nursing ExperienceCase ManagementUtilization ReviewStop-Loss Insurance KnowledgeCCM Certification

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentHigh-Cost Trajectory IdentificationActionable Underwriting GuidanceAdvocacy with Stop-Loss CarriersMedical Record Review

Soft Skills

Clinical Education DeliveryInterpersonal Communication

Certifications & Qualifications

Active RN LicenseCCM Certification

Industry Keywords

Acute Care SettingTPA OperationsSelf-Funded Health PlansHMOPPOReinsurance Firm

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

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

Comp & perks

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