Stop-loss Cost Containment Nurse (Contractor, Remote)

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Hamilton & Archer Health Services, LLC is a leading health care consulting and contracting company. We are seeking a contracted RN to assist with our stop-loss insurance case reviews.Job SummaryHamilton & Archer Health Services, LLC provides clinical and medical review expertise for cost of care related to stop-loss for its insurance clients. This position is responsible for reviewing stop-loss risk cases, assessing potential cost of care, and making recommendations on laser, risk projections, and other stop-loss related activities.Essential Duties and Responsibilities• Review stop-loss cases and make recommendations on potential cost of care, including lasers.• Apply established guidelines when conducting stop-loss case reviews.• Use reporting and risk identification tools on medical and pharmacy claims to assess risk.• Assist clients in evaluating risks in existing and potential stop-loss groups.• Respond to client inquiries and requests for additional information on large claimants.Education and Experience• Required: ASN or BSN in Nursing, licensed in state of residence.• Required: Minimum of 2 years of clinical experience.• Required: Minimum of 2 years of experience in the stop-loss insurance industry, health care delivery system/industry, payer experience, or cost-containment.• Required: Must understand stop-loss spec deductibles, policy year contract types and carve out programs.Knowledge and Skills• Strong understanding of health and prescription costs.• Knowledge of healthcare delivery systems and providers.• Understanding of disease life cycles, disease progression, and expected health outcomes based on standard care management principles.• Preferred: Familiarity with stop-loss reporting tools, such as AMS, and requirements.• Preferred: Experience with risk mitigation, high claimant detection, and claimant engagement/management.• Strong interpersonal skills with demonstrated ability to collaborate across divisions and with external stakeholders.• Proficiency with MS Office (Word, Excel, PowerPoint, MS Project) in a Windows environment.Physical Demands• Ability to work from a HIPAA-compliant home office environment.Job Type: ContractPay: $39.00 - $50.00 per hourExpected hours: 10 – 40 per weekWork Location: Remote

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