Job Description

Position Overview

Ready to take your healthcare career to the next level?

RGAs ROSE Consulting Group is seeking a Medical Risk Consultant to join us in the nations premier reinsurance healthcare management consulting program in our Minneapolis, MN office.

RGAs ROSE Consulting Group fills a critical need in meeting the challenges of todays dynamic healthcare environment. You will be a part of a team that offers an array of industry-leading services and resources to manage complex claims, enhance operational efficiency, and improve patient care.

RGA is seeking a ROSE Medical Risk Consultants with both the clinical expertise and the depth of healthcare business experience to provide proven, targeted solutions that have a significant impact on the bottom line.

The Medical Risk Consultant, provide high quality case management and claims management consulting, including identification, assessment and management of high cost cases. Establishes reserves and ensures cost effective claims management. Promote client satisfaction and retention.

Responsibilities

Cost Containment

* Ensure cost effective case management consultation services for high cost cases. Consult with clients on case management issues, alternative levels of care, program development, quality improvement and educational needs.
* Ensure cost effective reinsurance claims management. Consult with clients on high cost claims management strategies. Establish reserves, authorize claim payments, assist with audits, determine need for extra contractual agreements, and monitor clients claims activity.
* Report industry trends and assist with care and cost management strategies to reduce claim costs for clients and RGA.

Client/Broker Relationship Management

* Work with RGA underwriting, account management and claims staff to improve service to customers and manage the customer relationship.
* Under limited supervision, communicate, market, and educate senior and middle management of current and prospective clients and brokers regarding program services available. Present appropriate information to prospective customers in sales presentations.

Business Management Support

* Assist in the underwriting process with regard to evaluation of claims experience, future risk, and clients case and claims management capabilities.
* Audit/review clients case management and claims management practices on a regular basis. Perform Operational Review (in-depth audit and formal report) of clients internal case management programs under supervision of Senior Medical Risk Consultant.
* Review reinsurance treaty (contract) wording for understanding/administrative interpretation; evaluate clients current and future claims trends and provide recommendations to improve contract clarity.
* Assist with planning and hosting educational events including bi-monthly teleconferences

Other

* Supports ad hoc requests.

Requirements

Education and Experience

Required

* Bachelors Degree in Nursing/related field, with 5-7 years of clinical experience, or Associate or Diploma Degree with 7-10 years of experience.
* 4-6 years case management experience.
* Current Registered Nurse license and/or current CRRN, CIRS, CCM or CRC certification
* Knowledge and expertise in health care system and practices

Preferred:

* Certified Case Manager
* Managed Care experience (either hospital or HMO/health insurance company).
* Cost Containment Experience (TPA, MGU, health plan)

Skills and Abilities

* Flexibility, takes initiative, and demonstrates accountability
* Intermediate oral and written communication skills demonstrating ability to share and impart knowledge
* Quickly adapts to new methods, works under tight deadlines and stressful conditions
* Intermediate level of investigative, analytical, math aptitude and problem solving skills
* Intermediate presentation skills
* Sets goals and handles multiple tasks, clients, and projects simultaneously; Ability to appropriately balance priorities, deadlines, and deliverables
* Works well within a team environment and participates in department/team projects
* Balances detail with departmental goals/objectives
* Fosters customer service as needed
* Translates business needs and problems into viable/accepted solutions
* Expert negotiating, persuasion, and conflict resolution skills
* General business knowledge including marketing, sales, and financial acumen
* Ability to travel 10-20%

Company Overview

Reinsurance Group of America, Incorporated (NYSE: RGA) is a leader in the global life reinsurance industry with approximately $2.9 trillion of life reinsurance in force and assets of $44.7 billion. We are one of the largest life reinsurance companies in the world.

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