Clinical Risk Manager Jobs in Summit, NJ (NOW HIRING)

Location: Hybrid 3 days (offices in NYC, Denver, CO and Charlotte, NC area)

Position Summary:

The Senior Analyst, Risk Management (PGs) supports the Risk Management function by maintaining the day-to-day governance, tracking, and reporting of client performance guarantees (PGs) and related contractual commitments across the client book of business. Operating within the Client Services, Account Advocacy & Risk Management team, the Analyst maintains the centralized PG database, produces performance and risk reporting, and partners cross-functionally with Legal, Finance, Analytics, and Client Services to improve data quality, clarify ownership, and mature the end-to-end PG process. The role blends risk and process-improvement work, managing risk-based initiatives from intake through execution, and operational analytics-identifying gaps and risk patterns and supporting initiatives that reduce the organization's contractual risk exposure.

Position Responsibilities:

• Maintain the centralized PG database (Jira Assets), entering and updating awarded PGs, contract amendments, and new client implementations, and reducing the ongoing data backlog.
• Reconcile and feed PG data into downstream reporting environments (e.g., Snowflake and Tableau) to support accurate dashboards and visibility into dollars at risk, contract counts, and PG counts.
• Design, build, and maintain operational dashboards, KPI reporting, and recurring trend analysis covering PG performance, contractual compliance, and risk exposure, translating data into insights for stakeholders.
• Analyze PG performance trends, contractual compliance metrics, and underlying data relationships to identify root causes, assess operational risk, support forecasting and variance analysis, and recommend process or reporting improvements
• Support client scorecard generation by centralizing and standardizing PG data sources, reducing reliance on manual, decentralized stakeholder requests.
• Help document and improve the end-to-end PG lifecycle (establishment, negotiation, approval, award, tracking, measurement, and reporting), assessing impacts, clarifying ownership, and recommending standardized practices.
• Maintain the PG data source inventory, ownership mapping, and methodology-review flags to capture risk signals and support governance decisions.
• Support governance of risk events through a structured identify-assign-track-close workflow, logging items, confirming owners, and following up to closure.
• Support automation of manual reporting and tracking processes and partner with stakeholders to improve data quality and reporting accuracy.
• Plan and execute risk-based initiatives end to end - structuring project plans, coordinating cross-functional workstreams, and tracking progress, dependencies, and action items to closure across Legal, Finance, Analytics, and Client Services partners.
• Support client audit activities and broader contractual-guarantee visibility (e.g., clinical and program guarantees) as part of the overall risk management framework.

Required Qualifications:

• Bachelor's degree or equivalent experience
• 3-5 years of experience in operations, contract support, healthcare or PBM administration, risk management, or process improvement
• Strong documentation, data-tracking, and organizational skills with high attention to detail and accuracy
• Strong problem-solving skills and a process-improvement mindset, with the ability to identify gaps, risks, and improvement opportunities
• Ability to collaborate and coordinate across cross-functional teams, including Legal, Finance, Analytics, and Client Services
• Proficiency with Excel and comfort working with data in reporting and dashboarding tools
• Experience coordinating or executing cross-functional projects or initiatives, including planning, tracking, and driving work to closure
• Experience analyzing data and building reporting or dashboards to translate information into actionable insights

Preferred Qualifications:

• Experience in a PBM, healthcare, or healthtech environment.
• Familiarity with performance guarantees, contractual compliance, or client audit processes.
• SQL and/or Python.
• Power BI or Tableau, and Excel Power Query.
• Business process mapping and workflow automation tools.
• Formal project management methodology, tools, or certification (e.g., Agile/Scrum, PMP).
• Experience with Jira / Jira Assets or comparable database and dashboarding tools.