Bill Review Nurse — Managed Care Specialist

Summit; Gainesville (GA); Hybrid; USD 77,000 - 109,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

401(k) with company match

Paid time off and holidays

Tuition reimbursement

Commuter benefits

Job summary

SCI Summit Consulting, LLC is seeking a Registered Nurse with extensive case management and managed care experience to review medical bills, negotiate services, and drive cost controls. The role emphasizes expert knowledge of managed care laws and strong analytical skills, with on-site four days a week and one remote day depending on business needs.

The ideal candidate has a Bachelor’s in Healthcare Management or related field, plus 14+ years in the arena.

Qualifications

• RN is required and healthcare degree is essential.
• At least 14 years in case management or managed care.
• Expert knowledge of managed care laws/regulations.
• Strong analytical skills to use data for decisions.

Responsibilities

• Reviews facility and professional bills against records for accuracy.
• Negotiates Pre-Surgical Services.
• Performs audits to identify leakage and process improvements.
• Provides expert advice to Claims staff on medical and cost controls.
• Mentors lower-level staff and may participate in talent decisions.
• On-site four days a week with one day remote; remote work possible.

Skills

Bill Review

Communication

Managed Care

Education

Bachelor's in Healthcare Management

Registered Nurse (RN)

Job description

SCI Summit Consulting, LLC is seeking a Registered Nurse with extensive case management and managed care experience to review medical bills, negotiate services, and drive cost controls. The role emphasizes expert knowledge of managed care laws and strong analytical skills, with on-site four days a week and one remote day depending on business needs.

The ideal candidate has a Bachelor’s in Healthcare Management or related field, plus 14+ years in the arena.