[Remote] Stop Loss Nurse Consultant

Note: The job is a remote job and is open to candidates in USA. Gravie is a company focused on transforming health benefits for small and midsize businesses, aiming to provide innovative, consumer-centric health solutions. They are seeking an experienced RN to serve as a Stop Loss Nurse Consultant, who will leverage clinical expertise and financial strategy to evaluate complex member cases and contribute to cost projections, collaborating with various teams to ensure high-quality care. Responsibilities • Use your knowledge to better understand the care journeys of complex members, often piecing together a puzzle from various sources of information. • Evaluate complex member cases to develop accurate cost projections, drawing from claims data, prior authorizations, industry trends, and other sources. • Provide clinical insights into likely treatment pathways (e.g., oncology, transplant, critical care, specialty drugs) to anticipate costs and inform underwriting decisions. • Collaborate with underwriting, stop-loss, clinical services, and actuarial teams to ensure projections align with both financial and clinical realities. • Identify early intervention opportunities (e.g., site-of-care optimization, alternative medications, post-acute care settings) to mitigate future high costs. • Interpret plan language and coverage details to anticipate financial impact and reduce avoidable member and group abrasion. • Synthesize findings into clear summaries and reporting for underwriters, actuaries, and leadership. • Work cross-functionally to improve processes for high-cost claimant identification, case flagging, and cost containment. • Combine your experience of evidenced based practice with being innovative to drive new solutions for the best member experience. • Create effective relationships, listen, communicate and be a helpful team member across the organization. Skills • Active RN license in the state hired. • Experienced with evaluation of risk for costs and health outcomes. • 10+ years of experience in clinical care, managed care, underwriting, or stop-loss risk evaluation. • Strong expertise in catastrophic claims cost drivers (e.g., oncology, transplants, neonatal/critical care, specialty pharmacy). • Proven ability to analyze risk and forecast costs using both clinical and financial data. • Exceptional verbal and written communication skills. • Demonstrated customer service, communication, and organizational skills. • Ability to work independently, prioritize effectively, and make sound decisions. • Previous experience at a high growth company. • Familiarity with actuarial models and tools or cost modeling platforms. • Previous experiences with working both Underwriting and Stop Loss teams. Education Requirements • Bachelor’s degree in nursing. Benefits • Alternative medicine coverage • Flexible PTO • Up to 16 weeks paid parental leave • Paid holidays • A 401k program • Cell phone reimbursement • Transportation perks • Education reimbursement • 1 week of paid paw-ternity leave Company Overview • Gravie is an insurance company that designs health benefits plans for small and midsize employers. It was founded in 2013, and is headquartered in Minneapolis, Minnesota, USA, with a workforce of 201-500 employees. Its website is https://www.gravie.com. Apply tot his job Apply To this Job