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Stop Loss Rn Jobs in Illinois (NOW HIRING)

Captive Resources

Clinical Risk Specialist RN

Itasca, IL · On-site

$137K - $150K/hr

The Clinical Risk Specialist RN is responsible for providing high quality case management and ... Reviewing stop-loss cases, making recommendations on potential cost of care, including lasers ...

Swiss Re

Clinical Risk Manager

Schaumburg, IL · Hybrid

$84K - $140K/yr

Minimum of Associate or Bachelor's degree in nursing with at least 1 year of Stop Loss Nursing experience * Must have up to date registered nurse (RN) license * Able to demonstrate a track record of ...

Hallmark of Pekin

Registered Nurse RN

Pekin, IL · On-site

$42 - $50/hr

) Join Our Team as a Registered Nurse (RN) Location: Hallmark Healthcare of Pekin, Pekin, IL Shift ... Apply online or stop by in person today: 2501 Allentown Road, Pekin, IL 61554 Apply Online: We look ...

Hallmark Healthcare of Pekin

Registered Nurse RN

Pekin, IL · On-site

$42 - $50/hr

Join Our Team as a Registered Nurse (RN) Location: Hallmark Healthcare of Pekin, Pekin, IL Shift ... Apply online or stop by in person today: 2501 Allentown Road, Pekin, IL 61554 Apply Online: We look ...

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All JobsStop Loss Rn JobsStop Loss Rn Jobs in Illinois

Stop Loss Rn information

How to make $200,000 as a nurse?

As a nurse, reaching a $200,000 salary typically involves gaining advanced certifications, specializing in high-demand areas like anesthesia or nurse practitioner roles, and working in settings such as travel nursing or private agencies that offer higher pay. Increasing experience, working overtime, and pursuing leadership or administrative positions can also boost earnings.

What are the typical daily responsibilities of a Stop Loss RN?

As a Stop Loss RN, your typical day involves reviewing high-cost medical claims, verifying the medical necessity of treatments, and assessing policy compliance to determine insurance coverage. You’ll collaborate closely with clinical staff, insurance specialists, and sometimes directly with healthcare providers to gather relevant information and ensure accurate case evaluations. Many Stop Loss RNs also prepare detailed reports and participate in case conferences. This role often combines remote desk work with communications across multidisciplinary teams, creating a dynamic environment well-suited for nurses looking to leverage their clinical expertise in an insurance or administrative setting.

How to make an extra $2000 a month as a nurse?

As a nurse, increasing income by $2000 monthly can involve taking on overtime shifts, working in high-demand specialties, or pursuing per diem or travel nursing assignments that offer higher pay rates. Developing specialized skills or certifications, such as in critical care or anesthesia, can also qualify you for higher-paying roles or bonuses.

What jobs pay 4000 a week without a degree?

A Stop Loss RN can potentially earn around $4,000 weekly through high-volume, specialized roles in healthcare, especially with experience and certifications. Other high-paying jobs without a degree include sales positions, real estate agents, and certain skilled trades like commercial diving or oilfield work, which often rely on experience and performance bonuses. These roles typically require strong skills, certifications, or licenses rather than formal degrees.

What are the key skills and qualifications needed to thrive in the Stop Loss Rn position, and why are they important?

To thrive as a Stop Loss RN, you need in-depth clinical nursing experience, a strong understanding of insurance policies and claims, and RN licensure. Familiarity with medical claims adjudication systems, electronic health records, and utilization review platforms is typically required. Excellent communication, critical thinking, and attention to detail set top performers apart in this role. These skills are important to effectively review complex medical cases, ensure appropriate healthcare coverage, and collaborate with both providers and insurers.

What is a Stop Loss RN job?

A Stop Loss RN is a registered nurse who reviews medical claims and patient records to evaluate the necessity, accuracy, and cost of healthcare services for insurance companies or employers. They help determine whether claims exceed stop-loss insurance thresholds, which protect insurers or self-funded employers from excessive financial risk. This role involves assessing medical necessity, verifying coding accuracy, and collaborating with case managers, providers, and insurance teams. Strong analytical skills and clinical expertise are essential for making informed decisions on high-cost claims.

What does a stop loss nurse do?

A stop loss nurse manages and monitors insurance claims related to stop loss coverage, which protects employers from high-cost healthcare expenses. They review medical claims, ensure compliance with policy terms, and collaborate with healthcare providers and insurance companies to process claims accurately. Strong knowledge of healthcare billing, insurance policies, and attention to detail are essential for this role.
What are popular job titles related to Stop Loss Rn jobs in Illinois? For Stop Loss Rn jobs in Illinois, the most frequently searched job titles are:
What job categories do people searching Stop Loss Rn jobs in Illinois look for? The top searched job categories for Stop Loss Rn jobs in Illinois are:
What cities in Illinois are hiring for Stop Loss Rn jobs? Cities in Illinois with the most Stop Loss Rn job openings:
Stop Loss Rn jobs near you

Clinical Risk Specialist RN

Captive Resources

Itasca, IL

$137K - $150K/hr

Full-time

Posted 15 days ago

Job description

The Clinical Risk Specialist RN is responsible for providing high quality case management and claims management consulting, including identification, assessment and projections of high-cost cases to assist in the underwriting process.

ESSENTIAL EDUCATION AND EXPERIENCE: ASN or BSN in nursing licensed in the State of Residence; at least two (2) years of clinical experience, AND at least two (2) years of stop loss or health payer experience.

SKILLS/COMPETENCIES REQUIREMENTS:

  • Reviewing stop-loss cases, making recommendations on potential cost of care, including lasers recommendations.
  • Use established guidelines when conducting stop-loss case reviews.
  • Works with underwriting team to identify potential high-risk claimants in new business and renewal groups.
  • Elicits support from sales and account management, and underwriting.
  • Use reporting and risk identification tools on medical and pharmacy claims to assess risk.
  • Assists in responding to inquiries from underwriting and sales for additional information on large claimants.
  • Review of monthly TPA reporting on current business for reserving.
  • Understanding of health and prescription costs.
  • Understanding of health delivery systems and professionals.
  • Understanding of disease life cycle, disease progression, expected health outcomes based on standard, accepted care management principles.
  • Understanding of stop loss reporting tools and requirements preferred.
  • Understanding of risk mitigation, high claimant detection, engagement and management preferred.
  • Requires strong interpersonal skills with a demonstrated ability to work across divisions and with external stakeholders.
  • Requires proficiency in the use of MS Office, AMS product suite, and ESL Office (Connexure/David Young).

TRAVEL: Occasional travel may be required for meetings, conferences, or client visits. This includes compliance with all of the requirements of the localities and destinations, as well as transportation carrier requirements.

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