Stop Loss Nurse Consultant

Remote

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health Insurance, Benefits SolutionsIndustries

Requirements

Candidates must possess a Bachelor's degree in nursing and an active RN license in the state of hire. A minimum of 10 years of experience in clinical care, managed care, underwriting, or stop-loss risk evaluation is required, along with proven expertise in catastrophic claims cost drivers and the ability to analyze risk and forecast costs using both clinical and financial data. Strong verbal and written communication skills, customer service, and organizational skills are essential, as is the ability to work independently, prioritize effectively, and make sound decisions. Experience with high-growth companies, familiarity with actuarial models or cost modeling platforms, and prior experience with both Underwriting and Stop Loss teams are considered advantageous.

Responsibilities

The Stop Loss Nurse Consultant will evaluate complex member cases to develop accurate cost projections by piecing together information from various sources, including claims data and prior authorizations. They will provide clinical insights into likely treatment pathways to anticipate costs and inform underwriting decisions. This role involves collaborating with underwriting, stop-loss, clinical services, and actuarial teams to ensure projections align with financial and clinical realities. Responsibilities include identifying early intervention opportunities to mitigate future high costs, interpreting plan language to anticipate financial impact, and synthesizing findings into clear summaries and reporting for leadership. The consultant will also work cross-functionally to improve processes for high-cost claimant identification and cost containment, driving new solutions for the best member experience through evidenced-based practice and innovation.

Skills

Clinical Expertise

Financial Strategy

Risk Evaluation

Cost Projections

Claims Data Analysis

Treatment Pathway Analysis

Underwriting

Stop-loss

Actuarial

Early Intervention

Site-of-care Optimization

Registered Nurse

Gravie

Health benefits and insurance solutions provider

About Gravie

Gravie provides health benefits by offering straightforward and affordable health plans, primarily targeting individuals and small to midsize businesses. Their main product, Comfort, stands out because it has no deductible and no copays for most common healthcare services, allowing members to access care without unexpected costs. Additionally, Comfort includes virtual care options for musculoskeletal and mental health issues. Gravie also offers a payment solution called Gravie Pay, which enables members to pay for healthcare expenses interest-free, further easing financial stress. Unlike traditional health plans, Gravie claims that Comfort members save on out-of-pocket costs, and employers switching to Gravie often see lower premium expenses. The company has a high retention rate, indicating that many employees choose to continue with the Comfort plan in subsequent years. Gravie's goal is to simplify health benefits and reduce the financial burden of healthcare for its members.

Minneapolis, MinnesotaHeadquarters

2013Year Founded

$333.3MTotal Funding

DEBTCompany Stage

Fintech, HealthcareIndustries

201-500Employees

Benefits

Health Insurance

401(k) Retirement Plan

401(k) Company Match

Paid Holidays

Paid Vacation

Paid Sick Leave

Flexible Work Hours

Paid Parental Leave

Wellness Program

Alternative Medicine Coverage

Cell Phone Reimbursement

Transportation Perks

Education Reimbursement

Paid Paw-ternity Leave

Risks

Potential backlash from traditional insurers could increase competition or lobbying.

Rapid ICHRA adoption may invite regulatory scrutiny or changes.

Aggressive expansion strategy could strain resources and lead to inefficiencies.

Differentiation

Gravie's Comfort plan offers zero deductibles and copays, unlike traditional health plans.

Gravie Pay provides interest-free payment solutions, reducing financial burdens for members.

Focus on virtual healthcare services enhances accessibility and member satisfaction.

Upsides

Increased ICHRA adoption since 2020 expands Gravie's market opportunities.

Comfort plan's zero-deductible model attracts cost-conscious employers and employees.

Virtual healthcare services align with rising demand, boosting member engagement.

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