Clinical Nurse Supervisor - Claims & Compliance Leader

Gainwell Technologies; Jackson (MS); Hybrid; USD 85,000 - 100,000; Full time

Benefits offered by this job

Generous vacation policy

401(k) employer match

Comprehensive health benefits

Educational assistance

Leadership academies

Job summary

Gainwell Technologies is seeking a Clinical Nurse Supervisor in Mississippi to lead a team of RNs and coding professionals. The role supports clinical claims processing, regulatory compliance, and operational excellence in a hybrid, full-time setting.

You will oversee claims review, coding accuracy, and performance metrics, while collaborating with providers and departments to drive efficiency and quality outcomes. Position starts onsite in Jackson, MS with potential remote work after onboarding.

Qualifications

• ADN required; RN license in Mississippi or Compact State/NLC.
• Bachelor's degree in Nursing, Healthcare Administration, or related field preferred.

Responsibilities

• Lead and oversee daily clinical operations for RNs and Certified Coding professionals, ensuring productivity, quality, compliance, and attainment of operational goals.
• Manage clinical claims review and processing activities, including medical necessity reviews, audits, reconsiderations, utilization management support, and resolution of complex DRG and OPPS issues.
• Ensure accurate, timely, and compliant claims processing per payer policies, CMS, Mississippi Medicaid, contractual requirements, and organizational standards.
• Provide oversight of CPT, HCPCS, and related coding functions, ensuring accuracy and regulatory compliance.
• Monitor performance metrics, SLAs, claims inventory, coding accuracy, staff productivity, turnaround times, and financial outcomes; develop reports for leadership.
• Analyze operational and clinical data to identify trends, denied-claim root causes, provider education opportunities, and improvement initiatives.
• Lead quality, compliance, risk management activities including HIPAA audits and corrective action plans.
• Collaborate with internal stakeholders to improve efficiency, quality outcomes, and stakeholder satisfaction.

Skills

Leadership

Data analysis

Regulatory knowledge

Clinical judgment

Education

Associate Degree in Nursing

Bachelor's degree in Nursing/Healthcare Admin/Related field

Tools

CPT

HCPCS

ICD coding

Job description

Gainwell Technologies is seeking a Clinical Nurse Supervisor in Mississippi to lead a team of RNs and coding professionals. The role supports clinical claims processing, regulatory compliance, and operational excellence in a hybrid, full-time setting.

You will oversee claims review, coding accuracy, and performance metrics, while collaborating with providers and departments to drive efficiency and quality outcomes. Position starts onsite in Jackson, MS with potential remote work after onboarding.