Clinical Stop Loss Nurse

This is a fully remote position, open to applicants in Illinois, +4 more states.

📋 Description

• Analyze case management notes, extensive claims reports, and shock reporting for individuals and groups requesting stop loss insurance quotes and renewals.

• Collaborate closely with internal claims, clinical, and case management teams.

• Create ongoing care and cost projections.

• Convey projections to underwriting to assist in assessing potential risks and related expenses.

• Finalize cost projections for new and renewal business within 24–48 hours of receipt.

• Prepare a clinical summary and estimated cost of care for each individual identified as at risk.

⛳️ Requirements

• A bachelor's degree in nursing is preferred.

• Current state licensure is required.

• A minimum of 3–5 years of clinical experience.

• 2–4 years of experience with Stop Loss products and clinical programs.

• Strong analytical and problem-solving abilities.

• Exceptional organizational and time management skills.

• Capability to work independently with minimal supervision while managing multiple projects simultaneously.

• Outstanding written and verbal communication skills, particularly with underwriting staff.

• Ability to provide cost projections for new and renewal business within 24–48 hours of receipt.

• Proficiency in documenting a clinical summary and estimated cost of care for each individual identified as at risk.

• Proven track record of highly accurate, detail-oriented work.

• Competency in computer skills, strong typing abilities, and internet research capabilities.

• Thorough understanding of Microsoft Word, Microsoft Office, and Excel.

• Preferred: experience in clinical claims review and claims auditing.

• Preferred: background in managing complex or catastrophic health cases.

• Preferred: specialty clinical experience in intensive care medicine, orthopedic, NICU/pediatric, oncology, diabetic member management, or obstetric/maternity management.

• Preferred: progress toward or completion of CCM/CCP/CDE/MCG certification or an advanced degree.

• Preferred: familiarity with Milliman Guidelines or similar clinical guidelines.

• Preferred: understanding of medical management policies and procedures.

🏝️ Benefits

• Personalized development plans and opportunities for professional growth.

• Annual incentive bonus program.

• Comprehensive health and wellness benefits.

• 401(k) savings plan.

• Pension plan.

• Paid time off.

• Paid parental leave.

• Disability insurance.

• Supplemental life insurance.

• Employee assistance program.

• Paid holidays.

• Tuition reimbursement.

• Additional incentives.

• Drug-free and smoke-free workplace.

• Reasonable accommodations available during the application process.