Clinical Risk Manager
Position Summary
Ryan Specialty Benefits is seeking an experienced and clinically driven Clinical Risk Manager to join our dynamic Clinical Advisory Team. This is a unique opportunity to play a critical role within a rapidly growing organization that is redefining clinical risk management and stop loss cost containment.
As a Clinical Risk Manager, you will serve as a strategic clinical consultant, partnering closely with our brokers, carrier partners, TPAs, captive programs, specialty vendors, and employer-sponsored health plans to identify risk, evaluate high-cost claims, and develop innovative cost mitigation strategies. Your expertise will directly influence underwriting decisions, risk management initiatives, and financial outcomes for our clients.
This role is ideal for a clinically experienced Registered Nurse who enjoys combining clinical expertise with financial analysis, strategic problem-solving, and collaborative relationship management. You will become part of a highly engaged team focused on delivering meaningful results through clinical insights, proactive risk identification, and innovative mitigation solutions. What will your job entail?
What You'll Do
Clinical Risk Assessment & Analysis
- Analyze medical and pharmacy claims, clinical records, treatment plans, and emerging therapies to identify high-cost claim exposure and stop loss risk.
- Evaluate current and future claim liabilities, including complex cases involving oncology, transplants, specialty pharmacy, gene and cell therapy, catastrophic claims, and chronic conditions.
- Assess clinical severity, treatment patterns, and emerging risks to support stop loss underwriting and risk management decisions.
Cost Projection & Financial Modeling
- Develop accurate clinical cost projections for high-dollar claimants and complex cases.
- Monitor significant ongoing claims and identify potential changes in risk exposure.
- Provide detailed financial analyses and forecasting that support underwriting, renewal, captive, and carrier decision-making.
Risk Mitigation Strategy Development
- Partner with brokers, carriers, TPAs, case management teams, specialty vendors, and employer groups to identify opportunities for cost containment and risk reduction.
- Evaluate and recommend clinical and financial mitigation solutions, including:
- Specialty pharmacy optimization
- Biosimilar conversion opportunities
- Site-of-care management
- Centers of Excellence utilization
- Case management intervention
- Transplant management programs
- Gene and cell therapy solutions
- Alternative funding and assistance programs
- Collaborate with internal and external stakeholders to implement effective cost-management strategies that improve outcomes while controlling plan spend.
Captive and Client Support
- Support captive risk management initiatives through ongoing clinical reviews and risk assessments.
- Present complex clinical information in a concise, actionable manner for clients, brokers, captives, carrier partners, and executive leadership.
- Serve as a trusted clinical resource during renewal discussions, prospect evaluations, and risk management consultations.
Collaboration & Relationship Management
- Work closely with Ryan Specialty Benefits consultants, producers, underwriting partners, TPAs, brokers, carriers, and specialty vendors.
- Foster strong strategic relationships that support innovative client solutions and exceptional service delivery.
- Participate in multidisciplinary discussions to identify trends, share best practices, and improve overall risk management outcomes.
Reporting & Documentation
- Maintain accurate documentation of clinical analyses, cost projections, and mitigation recommendations.
- Prepare reports, presentations, and executive summaries that communicate clinical risk and financial impact to diverse audiences.
- Monitor outcomes and effectiveness of implemented mitigation strategies.
Qualifications
Education