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Stop Loss Rn Jobs in Texas (NOW HIRING)

Palm Medical Centers

RN Clinical Coordinator

Dallas, TX · On-site

$75K/yr

RN Clinical Coordinator Palm Primary Care is a rapidly growing company currently seeking an ... Communicate potential catastrophic and stop loss patients. * Identify patients related to possible ...

Palm Medical Centers

RN Clinical Coordinator

Dallas, TX · On-site

$75K/yr

The RN Clinical Coordinator performs a variety of tasks and coordinates the plans of care for ... Communicate potential catastrophic and stop loss patients * Identify patients related to possible ...

Palm Medical Centers

RN Clinical Coordinator

Dallas, TX · On-site

$70K/yr

The RN Clinical Coordinator performs a variety of tasks and coordinates the plans of care for ... Communicate potential catastrophic and stop loss patients * Identify patients related to possible ...

Matrix Pharmacy Group

Registered Nurse

Dripping Springs, TX · On-site

$28 - $45/hr

Registered Nurse (RN) Location: Dripping Springs, TX Are you a compassionate and skilled Registered ... Support weight loss and hormone optimization programs under provider guidance * Assist with patient ...

Matrix Pharmacy Group

Registered Nurse

Dripping Springs, TX · On-site

$28 - $45/hr

Registered Nurse (RN) Location: Dripping Springs, TX Are you a compassionate and skilled Registered ... Support weight loss and hormone optimization programs under provider guidance * Assist with patient ...

OneStopRecruiting

Registered Nurse (RN)

Dallas, TX · On-site

$43 - $48/hr

Registered Nurse (RN) Dallas, TX Overview: Our growing Home Health team is seeking an experienced ... Johnathan Gomez JOB-11743 #ALLIND One Stop Recruiting is an equal opportunity employer. We offer ...

BSW Hospital Med Lake Pointe

RN

Rowlett, TX · On-site

$2.2K/wk

Details Client Name BSW Hospital Med Lake Pointe Job Type Travel Offering Nursing Profession RN ... You can reply "STOP" anytime to unsubscribe or send e-mail at nexusqueries@talent4health.com.

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BSW Medical Center-Buda

RN

Creedmoor, TX · On-site

$2.3K/wk

Details Client Name BSW Medical Center-Buda Job Type Travel Offering Nursing Profession RN ... You can reply "STOP" anytime to unsubscribe or send e-mail at nexusqueries@talent4health.com.

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Stop Loss Rn information

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.

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?

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 are popular job titles related to Stop Loss Rn jobs in Texas?

For Stop Loss Rn jobs in Texas, the most frequently searched job titles are:

What job categories do people searching Stop Loss Rn jobs in Texas look for?

The top searched job categories for Stop Loss Rn jobs in Texas are:

What cities in Texas are hiring for Stop Loss Rn jobs?

Cities in Texas with the most Stop Loss Rn job openings:

Stop Loss Rn jobs near you
Infographic showing various Stop Loss Rn job openings in Texas as of August 2026, with employment types broken down into 3% As Needed, 61% Full Time, 13% Part Time, and 23% Contract. Highlights an 99% Physical, and 1% Remote job distribution.

Clinical Stop Loss Nurse - Work From Home

Health Care Service Corporation

Richardson, TX • On-site, Remote

$84K - $152K/yr

Full-time

Medical, Life, Retirement, PTO

Posted 6 days ago

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job SummaryThis position is responsible for the review of case management notes, large claims reports and shock reporting for individuals and groups seeking stop loss insurance quotes and renewals. The position works closely with internal claim, clinical and case management teams to develop ongoing care and cost projections. The projections are then communicated to underwriting to help evaluate potential risk and associated costs.

Required Job Qualifications:

  • Bachelor's degree in nursing is preferred with current state licensure and at least 3-5 years of clinical experience
  • 2-4 years experience with Stop Loss products and clinical programs
  • Strong analytical and problem solving skills
  • Excellent organizational and time management skills, able to work independently with little supervision while handling numerous projects at once
  • Excellent written/verbal communication skills, especially the ability to communicate effectively with underwriting staff
  • Ability to complete cost projections on new and renewal business within 24-48 hours of receipt
  • Documentation with clinical summary and estimated cost of care for each individual identified as at risk
  • Must have a track record of producing work that is highly accurate, demonstrates attention to detail, and reflects well on the organization
  • Computer proficiency, specifically strong typing skills and Internet research skills, must have a clear understanding of Microsoft Word, Microsoft Office and Excel.

Preferred Job Qualifications:

  • Clinical claims review and claims auditing experience
  • Experience in managing complex or catastrophic health cases
  • Specialty clinical experience in intensive care medicine, orthopedic, NICU/pediatric, oncology, diabetic member management, obstetric (low to high risk maternity management)
  • Working toward or completion of CCM/CCP/CDE/MCG certification or Advanced degree
  • Knowledge of Milliman Guidelines or similar clinical guidelines
  • Knowledge of medical management policies and procedures

#LI-MW2

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From 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, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plansubject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range$84,400.00 - $152,300.00

Exact compensation may vary based on skills, experience, and location.

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