Stop Loss Nurse Consultant

Hi, we’re Gravie. Our mission is to improve the way people purchase and access healthcare through innovative, consumer-centric health benefit solutions that people can actually use. Our industry-changing products and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way. A Little More About the Role: We’re looking for an experienced RN who thrives at the intersection of clinical expertise and financial strategy. You’ll take what we’re doing - creating a health plan people will love - and contribute to understanding our most complex members so we can mitigate and project costs as a Stop Loss Nurse Consultant to bring deep clinical insight into risk evaluation and cost projections for complex claimants. In this role, you’ll collaborate closely with Underwriting, Stop-loss, and Actuarial teams to shape smarter decisions, mitigate risk, and ensure high-quality, cost-effective care for our members. You will: • 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. You bring: • Bachelor’s degree in nursing. • 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. Extra credit: • 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. Gravie: In order to transform health insurance and build a health plan everyone can love, we need talented people doing amazing work. In exchange, we offer a great overall employee experience with opportunities for career growth, meaningful mission-driven work, and an above average total rewards package. The salary range for this position is $97,500 - $162,500 annually. Numerous factors including, but not limited to, educations, skills, work experience, certifications, etc. will be considered when determining compensation. Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard health and wellness benefits, Gravie’s package includes alternative medicine coverage, flexible PTO, up to 16 weeks paid parental leave, paid holidays, a 401k program, cell phone reimbursement, transportation perks, education reimbursement, and 1 week of paid paw-ternity leave. A Little More About Us: At Gravie, we're on a mission to reinvent health benefits for small and midsize businesses—making high-quality, affordable healthcare accessible to employers and their employees. We believe better benefits lead to better lives, and we’re building the future of health benefits to reflect just that. We’re proud to be the only company offering both innovative level-funded health plans and a market-leading ICHRA solution, giving employers more choice and flexibility than ever before. And guess what? Our customers love us. With member and employer satisfaction rates consistently trending above 80%, we know our health plans are working the way they should. Backed by some of the most sought-after investors in the country, we have the resources and long-term support to build something truly transformative—and we’re just getting started. At Gravie, we do things differently. We’ll challenge you, and we’ll welcome you challenging us. Good ideas are everyone's job here. You’ll join a team that’s smart, mission-driven, and unafraid to push boundaries if it means making a bigger impact for the people we serve. If you're energized by a high-performance, high-trust environment where your voice matters, Gravie might be just the place for you. We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us. Apply tot his job