Senior Nurse Reviewer

🔥 20 hours ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $78k - $99.2k / year

⏰ Full Time

🟠 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 in-depth reviews of medical claims using UB-04 forms and detailed itemized statements • Verify itemized charges according to client policy and industry standards • Conduct level-of-care and utilization reviews by analyzing medical records against criteria • Determine whether medical record documentation supports the need for services • Maintain production goals and quality standards • Assist management with training new reviewers through monitoring, mentoring, feedback, and education • Maintain current knowledge of clinical and coding guidelines and complete required CEUs • Attend training and scheduled meetings • Cross-train to review multiple claim types • Work with teams and company departments during normal business hours • Travel as required for business needs

🎯 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) • 5+ years of clinical experience in an inpatient hospital setting • 1+ year of itemized bill review experience • 3+ years of utilization review experience or claims auditing preferred • Experience with CPT, ICD-10, and HCPCS coding guidelines • Experience using MCG or InterQual criteria preferred • Ability to multitask in a fast-paced production environment • Work location within the continental United States • High-speed internet connection and distraction-free work environment • Ability to work during normal business hours • Ability to attend training and scheduled meetings • Ability to travel at least 10% of the time if required by business needs

🏖️ 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