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Medical Risk Consultant, RN
Virtue HealthClinical 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.
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
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Clinical AssessmentHigh-Cost Trajectory IdentificationActionable Underwriting GuidanceAdvocacy with Stop-Loss CarriersMedical Record Review
Soft Skills
Clinical Education DeliveryInterpersonal Communication
Certifications
Active RN LicenseCCM Certification