Director of Clinical & Cost Containment, Employee Benefits

Responsibilities

• Clinical Cost Containment Strategy
• Lead the development and ongoing refinement of SBR's clinical cost containment framework, aligning strategies with market trends and client needs
• Evaluate, vet, and recommend cost containment vendors and programs (utilization management, case management, pharmacy benefit management, transplant networks, reference-based pricing, direct primary care, etc.)
• Analyze claims data, clinical utilization trends, and high-cost claimant profiles to identify actionable savings opportunities
• Monitor medical cost trends, specialty drug pipelines, and catastrophic claim drivers to proactively advise clients and sales teams
• Stop-Loss Carrier Support / Claims Support
• Review TPA trigger reports and claim referrals to surface impending high-cost diagnoses and recommend clinical risk mitigation actions
• Identify and communicate coverage gap risks when Rx is carved out of stop-loss contracts or when benefit plan design creates clinical exposure
• Serve as clinical liaison between SBR, stop-loss carriers, TPAs, and employer plan sponsors on complex claims and risk management issues
• Consulting & Distribution Enablement
• Support SBR's sales and consulting teams with clinical presentations, client-facing materials, and technical talking points for broker/consultant audiences
• Conduct clinical reviews and plan analyses for prospective and existing employer clients, translating clinical findings into financial impact narratives
• Develop educational resources, webinars, and market-facing content that position SBR's clinical expertise as a competitive differentiator
• Partner with distribution leadership and brokers/consultants to align cost containment program recommendations with individual client risk profiles and plan designs
• Vendor Management & Program Oversight
• Build and maintain relationships with clinical cost containment vendors, including case management firms, utilization review organizations, PBMs, and specialty program providers
• Evaluate vendor performance through KPI monitoring, outcome tracking, and savings validation
• Negotiate program terms and coordinate seamless integration of clinical vendors within the SBR distribution ecosystem
• Stay current on regulatory developments, ERISA compliance requirements, and clinical best practices affecting self-funded plan design
• Internal Leadership & Collaboration
• Partner with the Chief Strategy Officer, COO, and sales leadership to align clinical strategy with SBR's overall growth objectives
• Provide clinical training and education to internal SBR teams, ensuring consultants can confidently represent cost containment solutions
• Contribute to the development of SBR's strategic plan as it relates to clinical program expansion, new vendor partnerships, and market positioning

Requirements

• Required
• Bachelor's degree in Nursing, Healthcare Administration, Health Sciences, or a related clinical field; RN license strongly preferred
• 5+ years of experience in clinical cost containment, case management, utilization management, stop-loss, or self-funded health plan consulting
• Deep knowledge of self-funded employer benefit plan design, stop-loss insurance structures, and the TPA/wholesale distribution market
• Demonstrated understanding of medical coding

Benefits

Additional Information

Position Summary The Director of Clinical & Cost Containment is a senior strategic role within Strategic Benefit Resources (SBR) responsible for leading the clinical consulting and cost containment program capabilities that differentiate SBR's self-funded solutions in the wholesale distribution market. This individual serves as the primary clinical subject matter expert across SBR's book of business, partnering with sales, distribution, and stop-loss consulting teams to evaluate, implement, and communicate clinical cost containment strategies that drive measurable financial outcomes for employer clients. This role bridges clinical expertise and consultative sales support - working directly with broker/consultant partners, TPAs, stop-loss carriers, and employer plan sponsors to identify high-cost claim drivers, optimize vendor program selection, and develop clinical frameworks that reduce plan cost and improve member outcomes. Why This Role Exists As the self-funded benefits market grows increasingly complex - driven by specialty drug spend, catastrophic claim frequency, and heightened employer demand for transparency - SBR's distribution model requires dedicated clinical leadership to: Evaluate and validate cost containment vendor solutions (Rx carve-outs, case management, utilization review, reference-based pricing, direct contracting) presented to clients Provide clinical oversight and credibility in stop-loss consulting engagements Identify coverage gap risks (e.g., Rx carved out of medical stop-loss) and proactively protect clients and SBR's risk profile Position SBR as a value-added clinical advisory resource to differentiate from transactional wholesale competitors

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