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.

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.

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.