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Stop Loss Rn Jobs (NOW HIRING)

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 ...

One Stop Recruiting

Registered Nurse

Lexington, KY · On-site

$36 - $40/hr

Registered Nurse (RN) Location: Lexington, KY Employment Type: Full-Time | Permanent Schedule: 12 ... One Stop Recruiting is an equal opportunity employer. We offer equal employment and contract ...

Novacore

Technical Underwriter

Conshohocken, PA · On-site

Carbon Stop Loss Solutions is a leading managing general underwriter (MGU) in the field of employer ... Send Off Initial Nurse Review * Run Renewal Reports * Complete Matrix * Enter Aggregate and Shock ...

Novacore

Technical Underwriter

Conshohocken, PA · Hybrid

Carbon Stop Loss Solutions is a leading managing general underwriter (MGU) in the field of employer ... Send Off Initial Nurse Review * Run Renewal Reports * Complete Matrix * Enter Aggregate and Shock ...

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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 Sep 13, 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 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.

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Stop Loss Rn jobs near you
Infographic showing various Stop Loss Rn job openings in the United States as of September 2026, with employment types broken down into 50% Full Time, and 50% Part Time. Highlights an 83% In-person, and 17% Hybrid job distribution, with an average salary of $114,374 per year, or $55 per hour.

RN Clinical Coordinator

Dallas, TX • On-site

Palm Medical Centers
Outpatient Health Care • 51 - 200 employees
Learn more about Palm Medical Centersexternal

$75K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

Palm Primary Care is a rapid growing company currently seeking an experienced RN Clinical Coordinator with leadership experience to join our team.
The RN Clinical Coordinator performs a variety of tasks and coordinates the plans of care for hospital and nursing home patients, from admission to discharge to ensure the continuation of care is provided effectively and efficiently.
Reports directly to the Senior Director of Utilization Management in the Utilization Management Department.
Responsibilities include:
  • Admit new clients by reviewing records and applications; conduct orientations.
  • Communicate the daily tracking of all hospital/nursing home admissions and discharge for both statistical and cost management purposes.
  • Determine clients' requirements by completing intake interviews; Determine need for therapeutic medical, psycho-social, and psychiatric evaluations, review therapist evaluations, treatment objectives, and plans.
  • Establish treatment programs by setting schedules and routines; coordinate services being provided; arrange resources- including transportation and escort.
  • Monitor cases by verifying clients' attendance; observe and evaluate treatments and responses; advocate for needed services and entitlements; obtain additional resources; ability to intervene in moments of crises by providing personal support.
  • Maintain clients' records by reviewing case notes, logging events and progress.
  • Communicates with PMC managers on members discharged from inpatient facilities to assure appropriate medical care follow up
  • Obtain weekly update on all nursing home patients
  • Communicate potential catastrophic and stop loss patients
  • Identify patients related to possible subrogation and/or cost allocations
  • Coordinate the transfers of patients as instructed by the Medical Director or PCP.
  • Arrange direct admissions to hospitals and placement in nursing homes
  • Assist PCP in placing patients at SNF
  • Monitor length of stay (LOS) for both hospital and nursing home patients and make necessary discharge arrangements
  • Communicate clients' progress by conducting weekly interdisciplinary meetings and evaluations, disseminating results and obstacles to therapeutic team and family, identify treatment influences.
  • Improve staff competence by providing educational resources; balancing work requirements with learning opportunities; evaluating the application of learning to changes in treatment results.
  • Improve treatment results by studying, evaluating, and re-designing processes, implementing changes, rewriting policies and procedures.
  • Improve financial status by analyzing results, monitoring variances, identifying trends, and recommending actions to management.

Requirements:
  • Proven working experience in case management- including as an RN, medical, mental health care manager or a related job experience
  • Excellent knowledge of case management principles, management and reimbursement
  • Previous experience with psychological aspects of care
  • Effective communication skills
  • Excellent organizational and time management skills
  • Familiarity with professional and technical emerging knowledge
  • Problem solving skills and ability to multi-task
  • Compassionate with teamwork skills
  • Knowledge of terminology CPT codes and ICD 10
  • Bilingual preferred
  • Knowledge of InterQual or Milliman Care Guidelines preferred

Minimum Qualifications: Active TX RN license, minimum 3 years of RN Clinical Coordinator experience.
Job Type: Full-time
Salary: From $75,000.00 per year (negotiable based on experience)
Benefits:
  • 401(k)
  • Dental insurance
  • Employee assistance program
  • Flexible spending account
  • Health insurance
  • Life insurance
  • Paid time off
  • Vision insurance

Schedule:
  • Day shift
  • Monday to Friday

Ability to commute/relocate:
  • Dallas Area: Reliably commute or planning to relocate before starting work (Required)

Experience:
  • Case management: 3 years (Required)

Work Location: Hybrid (In-office, On-site 3 locations)
Palm is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. Palm makes hiring decisions based solely on qualifications, merit, and business needs at the time.

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