Case Manager RN - Medical Risk Consultant

Symetra Financial is a family of companies with nearly a half-century of experience providing retirement plans, employee benefits, annuities and life insurance through independent distributors nationwide. The company has more than $20 billion in assets and is owned by an investor group led by White Mountains Insurance Group Ltd. and Berkshire Hathaway Inc.Summary:
Broad nursing experience highly valued
Most communication done telephonic or via email
Positions in Miami and/or Bellevue
Responsibilities:
Utilize your medical knowledge! Symetra Financial is looking for an experienced case manager who is interested in collaborating with underwriters to assess risk on catastrophic medical claims. If you possess a solid base of medical knowledge and understand treatment protocols for significant health issues please consider Symetra. Position responsibilities include: Maximize profitability of excess loss block of business by generating claim savings and minimizing potential risk to Symetra and policyholders. Identify potential risk early and partner with Third Party Administrators (TPA) to implement appropriate managed care interventions. Collaborate with Underwriting to assess and project cost of potential and known risks. Also, provide Underwriters with cost of risks to rate and sell new and renewal business within 24 hours or sooner if Underwriter requires faster response. Partner with vendors to identify and supplement TPA managed care programs. Negotiate discounts on ongoing claims. Review and prioritize notices of potential risks daily in order to identify significant risks and alert business partners as appropriate. Identify geographical healthcare trends in assigned geographic marketplace and implement managed care solutions. Recommend contracting opportunities with managed care vendors and PPO networks in assigned geographical region. Identify and support training opportunities for TPA and vendors when knowledge gaps are discovered. REQUIREMENTS
Registered Nurse Insurance experience/knowledge and industry education (i.e. LOMA, HIAA, ICA, etc.) preferred. CCM certification preferred. Excellent PC skills with prior use of office software with excellent typing skills. Ability to work independently and in teams. Must establish strong working relationships with both internal and external customers. Ability to negotiate and influence others because of excellent communication and organizational skills. Knowledge of disease process. 4-5 years clinical experience and 2-3 years Case Management experience ~cb~