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Stop Loss Rn Jobs (NOW HIRING)

Jzanus Consulting

Nurse Auditor

Garden City, NY · On-site

$87K/yr

Registered Nurse licensed in New York preferred. 3+ years' experience in hospital setting preferred ... HMO/PP, EOB, stop loss, etc.) and payment methodologies. Excellent communication skills required.

Grove Nursing Center

Registered Nurse (RN)

Grove, OK · On-site

$34/hr

Double Weekends RN with Baylor pay---part time position also available. Primary Purpose of this ... loss, general malaise or decreased range of motion(ROM); conduct assessments and notify the ...

Cynet Health

Registered Nurse (RN)

Gastonia, NC

$2.0K/wk

Details Client Name CaroMont Health Job Type Travel Offering Nursing Profession RN Specialty ... Email or text HELP for more info, or STOP to unsubscribe. Your mobile info will not be shared with ...

TLC NURSING SERVICES

RN

Temple, TX

$2.2K/wk

... Travel Offering Nursing Profession RN Specialty Registered Nurse Job ID 18369655 Job Title RN ... You can reply "STOP" anytime to unsubscribe or send e-mail at nexusqueries@talent4health.com.

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Stop Loss Rn information

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$68K

$114.4K

$206K

How much do stop loss rn jobs pay per year?

As of Jun 21, 2026, the average yearly pay for stop loss rn in the United States is $114,374.00, according to ZipRecruiter salary data. Most workers in this role earn between $98,500.00 and $126,500.00 per year, depending on experience, location, and employer.

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 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.

More about Stop Loss Rn jobs
What cities are hiring for Stop Loss Rn jobs? Cities with the most Stop Loss Rn job openings:
What are the most commonly searched types of Stop Loss Rn jobs? The most popular types of Stop Loss Rn jobs are:
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Stop Loss Rn jobs near you
Infographic showing various Stop Loss Rn job openings in the United States as of June 2026, with employment types broken down into 68% Full Time, and 32% Part Time. Highlights an 97% Physical, 1% Hybrid, and 2% Remote job distribution, with an average salary of $114,374 per year, or $55 per hour.
APRN - Medical Management (Value-Based Care)

APRN - Medical Management (Value-Based Care)

Palm Medical Centers

Tampa, FL • Hybrid

$93K - $127K/yr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 17 days ago

Job description

APRN – Medical Management

Palm Medical Centers is a rapidly growing, value-based primary care organization and a recognized leader in senior care across Florida, with over 30 locations and a 98% patient satisfaction rating. Our mission is to deliver personalized, preventative, and compassionate care while keeping patients healthier and out of the hospital. Our value-based model allows providers to spend more time with patients, focus on outcomes—not volume—and make a measurable impact on quality of life.

The APRN – Medical Management role is a hybrid clinical leadership and care coordination position designed to reduce hospital admissions, readmissions, and avoidable SNF utilization through proactive medical management, care transitions, and interdisciplinary collaboration. This APRN will work closely with PCPs, Medical Directors, case management, and external facilities to ensure high-risk patients receive timely, coordinated, and appropriate care across settings.

Key Responsibilities

Clinical & Medical Management

  • Provide advanced clinical oversight for high-risk and complex patients in a value-based primary care model
  • Perform medical management for patients with frequent hospitalizations, chronic disease burden, or care gaps
  • Support PCPs with care planning, post-discharge follow-up, and escalation of care needs
  • Assist with direct hospital admissions, SNF placement, and discharge planning when clinically appropriate
  • Monitor and manage length of stay (LOS) for hospital and nursing home patients

Utilization & Care Coordination

  • Track daily hospital and nursing home admissions, discharges, and transfers
  • Coordinate transitions of care to reduce readmissions and adverse outcomes
  • Obtain weekly updates on nursing home patients and communicate changes to internal teams
  • Identify potential catastrophic, stop-loss, or high-cost cases
  • Support subrogation and cost-allocation identification as needed

Interdisciplinary Collaboration

  • Lead or participate in interdisciplinary case conferences and care reviews
  • Communicate with patients, families, hospitals, SNFs, and community resources
  • Advocate for medically necessary services, diagnostics, and follow-up care
  • Coordinate transportation, community services, and ancillary resources

Quality, Process & Performance Improvement

  • Evaluate workflows, utilization patterns, and care processes to improve outcomes
  • Support quality initiatives tied to Medicare Advantage, Medicare, and Medicaid metrics
  • Contribute to policy, procedure, and workflow redesign
  • Provide education and guidance to clinical staff to improve care coordination competency

Documentation & Compliance

  • Maintain accurate, timely clinical and utilization documentation in the EMR (eCW preferred)
  • Ensure compliance with value-based care requirements, payer guidelines, and regulatory standards
  • Apply knowledge of CPT, ICD-10, and utilization review principles
Qualifications

Required

  • Active, unrestricted Florida APRN license
  • DEA license or eligible to obtain within 60 days of hire
  • 2–3+ years of experience in primary care, geriatrics, or internal medicine
  • Experience in value-based care, Medicare Advantage, Medicare, and/or Medicaid populations
  • Strong knowledge of chronic disease management, preventative care, and quality metrics
  • Excellent communication, organization, and problem-solving skills

Preferred

  • Background in case management, utilization management, or care coordination
  • Familiarity with InterQual or Milliman Care Guidelines
  • Prior RN case management or clinical coordination experience
  • Bilingual (Spanish/English)
What We Offer
  • Competitive compensation with performance incentives
  • 401(k) with employer contribution
  • Medical, dental, vision, disability, life, and malpractice insurance
  • Generous PTO, CME time, and paid company holidays
  • Monday–Friday day schedule with no weekends or on-call
  • Career development and leadership growth opportunities

Palm Medical Centers is an Equal Opportunity Employer committed to diversity and inclusion. Hiring decisions are based on qualifications, merit, and business needs.

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