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Stop Loss Rn Jobs in Texas (NOW HIRING)

Palm Medical Centers

RN Clinical Coordinator

Azle, 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

Azle, 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

Azle, 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-1

RN Clinical Coordinator

Azle, 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

$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 ...

Palm Medical Centers

RN Clinical Coordinator

Azle, 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 ...

NURSE's Etc. Staffing

Travel ER RN

Lubbock, TX · On-site

Minimum 2 years ER RN experience (hard stop). BLS, ACLS, PALS, NIHSS, and TNCC required. Facility: 379-bed Short Term Acute Care hospital and Level II Trauma Center. Dress Code: Solid navy blue ...

OneStopRecruiting

Registered Nurse (RN)

Dallas, TX · On-site

$42 - $46/hr

Registered Nurse (RN) Dallas, TX Overview: Our school-based health program in Dallas is seeking a ... Johnathan Gomez JOB-11824 #ESJ1 One Stop Recruiting is an equal opportunity employer. We offer ...

Childress Regional Medical Center

RN

Childress, TX · On-site

$2.0K/wk

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

Freestone Medical Center

RN

Fairfield, TX · On-site

$2.0K/wk

Details Client Name Freestone Medical Center 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 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 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 are popular job titles related to Stop Loss Rn jobs in Texas?

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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 September 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution.

Complex Claims Specialist - AMAP

Plano, TX • On-site

Lockton, Inc.
Insurance Services • 10K+ employees
Learn more about Lockton, Inc.external

Full-time

Re-posted 5 hours ago

Lockton rating

9.0

Company rating: 9.0 out of 10

Based on 47 frontline employees who took The Breakroom Quiz

Job description

Job Summary:
Description - External
Lockton is currently seeking a Clinical Claims Specialist within our Specialty Practice unit. The objective of this role is to improve and reduce the severity of complex and catastrophic claims, reduce the cost of risk while improving the health of our employer client's employee health plan.
• Provide explanation of disease states and associated costs to internal and external stakeholders.
• Provide cost-of-care estimates used in the risk assessment of stop loss underwriting.
• Consult with and advise underwriting on medical/clinical care approaches, standards of care and research of data for new business and renewals.
• Serve as a resource regarding medical necessity issues, standards of care and analysis for the reimbursement of submitted stop loss claims.
• Review claims and clinical documents to identify and monitor opportunities to increase member quality of care and overall cost reduction.
• Collaborate with various key stake holders to strategize clinical and cost savings strategies and assist on execution of plan.
• Coordinate implementation of claims savings solutions with Lockton Client Service Teams, TPAs, and stop loss carriers including regular tracking to measure savings and plan performance.
• Manage and organize task lists and open items and cases.
• Attend team clinical rounds to discuss cases and strategy solutions.
Requirements:
Qualifications - External
Qualification
• Licensure as a RN or Bachelor's in Healthcare Management or related field.
• A minimum of 5 years of clinical/risk management experience.
• Experience and/or knowledge of health insurance processes.
• CCM, NANCM, or other certification or designation is a plus.
• Working knowledge or experience in quality and care management.
• Proven time management experience.
• Strong organizational skills with ability to handle multiple tasks, in a fast-paced environment.
• Excellent oral and written communication skills.
• Ability to translate complex clinical topics and subjects to a non-clinical audience.
• Demonstrated advanced analytical and problem-solving skills.
• Working knowledge of Microsoft products (Word, Outlook, PowerPoint)

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