Nurse Reviewer – IMR

🔥 8 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $78k - $88k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Perform clinical reviews to determine whether medical record documentation supports the need for services • Apply clinical criteria, coverage policies, utilization guidelines, and practice guidelines specific to the applicable contract • Assemble appeal packages for physician review for independent medical review (IMR) • Ensure clinical appropriateness of IMR determination letters • Triage and determine necessity of expedited IMR appeal requests using federal guidelines and state regulations • Perform level-of-care and utilization reviews by analyzing medical records against criteria • Apply critical thinking and decision-making skills while maintaining production goals and quality standards • Assist management with training new reviewers through monitoring, mentoring, feedback, and education • Maintain current knowledge of clinical criteria and/or coding guidelines • Attend training and scheduled meetings • Cross-train to perform reviews of multiple claim types • Collaborate frequently with the team and other company departments

🎯 Requirements

• Active, unrestricted RN license from the United States and in the primary home residency, or active compact multistate unrestricted RN license under the Nurse Licensure Compact (NLC), required • 5+ years clinical experience in an inpatient hospital setting required • 3+ years utilization review experience or claims auditing preferred • Experience using InterQual criteria required • Ability to multi-task in a fast-paced production environment • Work location within the continental US • High-speed internet connection • Work environment free from distractions • Ability to work during normal business hours • Ability to work extended hours or be on call every other weekend for business needs • May be required to travel at least 10% of the time based on business needs • Ability to complete required CEUs to maintain RN license

🏖️ Benefits

• Flexible hours • Work-life balance • Continuous learning and career development • Flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies • High-speed internet and distraction-free home work environment required (not a benefit) • Potential travel reimbursement not explicitly stated