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Underwriting and Stop Loss Nurse Consultant

Gravie

Gravie

Remote
Posted on Thursday, July 4, 2024
Hi, we’re Gravie. Our mission is to improve the way people purchase and access healthcare through innovative, consumer-centric health benefit solutions that people can actually use. Our industry-changing products and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way.
A Little More About Us:
· We know healthcare. Our company was founded and is still led by industry veterans who have started and grown several market-leading companies in the space.
· We are quickly becoming one of the fastest growing health benefits companies in the country. We have received numerous awards and accolades, including Inc. Magazine Best in Business Gold Medal award in 2021, and JMP Securities Top 50 Private Companies in Insurtech in 2022.
· We have raised money from top tier investors who share the same long-term vision as we do of building an industry defining company that will endure over the long run. We are well capitalized.
· Our customers like us. Our revenue churn is in the low single digits, in an industry where greater than 20% churn is common.
· Our culture is unique. We tend to be non-hierarchical, merit-driven, opinionated but kind people who thrive working in a high-performance, fast-paced environment. People at Gravie care deeply about making a positive impact in the lives of the people we serve. We may not be the right place for everybody, but if you get energized by doing work every day that focuses on putting consumers at the front of the line, we could be a great place for you. It takes unique people and diverse perspectives to deliver our results. We encourage you to be your authentic self – we like you that way.
A Little More About The role:
We’re looking for a Registered Nurse with Stop-Loss and Underwriting Risk consulting experience. You’ll take what we’re doing - creating a health plan people will love – and create a system for learning more about our most complex members. You’ll work directly with our Clinical Services, Underwriting, Stop Loss, Claims, and Reporting teams to dive deep and understand our most complex members. You’ll also work with our Gravie Care teams so they can help the member reach the best path forward.
You will:
· Use your knowledge to better understand the care journeys of complex members, often piecing together a puzzle from various sources of information.
· Relay to internal teams’ intervention opportunities and what interventions have been done.
· Use your knowledge of interventions such as chemotherapy regimens, transplant processes, pharmaceuticals, critical care stays including neonatal treatment, etc, to guide the team on likely treatment plans and next steps.
· Review pre-certification lists for holistic Utilization Management, especially for high dollar claimants.
· Work with network UM/CM vendors to design and review care and case management pathways for specific claimants.
· Identify opportunities for lower cost medication options including site of care and alternative benefit options.
· Work with our Case Management teams to best assist these members.
· Analyze different home care and post-acute options such as skilled nursing, rehabilitation, or home care with equipment and physical therapy in the home.
· Think critically about plan language to clarify coverage and make the member journey as seamless as possible.
· Bring together data and work directly with our Clinical Analytics and Reporting teams to give summaries of work being done and opportunities to intervene and improve.
· Combine your experience of evidenced based practice with being innovative to drive new solutions for the best member experience.
· Demonstrate a strong sense of accountability for high complexity members, working independently to relay information to various parties when relevant.
· Create effective relationships, listen, communicate and be a helpful team member across the organization.
You bring:
· Bachelor’s degree in nursing
· Active RN license in the state hired.
· Experienced with evaluation of risk for costs and health outcomes.
· 10+ years of experience that includes clinical and medical management, managed care, or stop loss/underwriting experience.
· Working knowledge of catastrophic claims cost and medical vendors
· Exceptional verbal and written communication skills
· Demonstrated customer service, communication, and organizational skills.
· Ability to work independently, prioritize effectively, and make sound decisions.
Competitive pay is standard. Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard benefits, Gravie’s package includes alternative medicine coverage, flexible PTO, 16 weeks paid parental leave, paid holidays, cell phone reimbursement, education reimbursement, and 1 week of paid paw-ternity leave just to name a few.