DRG Clinical Validation Nurse

TalentLNX LLC; United States; Remote; USD 70,000 - 90,000; Full time

Job summary

TalentLNX LLC is seeking a remote DRG Clinical Validation Nurse to join an established inpatient clinical review team. You will examine inpatient records from admission through discharge to confirm that coded diagnoses, procedures, and DRG assignments accurately reflect the patient’s clinical picture.

This full-time, direct-hire role blends acute care nursing with inpatient coding and reimbursement knowledge and is fully remote, offering stability and opportunities to impact hospital

Qualifications

• Active, unrestricted compact (multistate) RN license.
• 3+ years of acute care nursing in ICU, ED, step down, or other high acuity setting.
• 2+ years of inpatient DRG validation, clinical validation, or inpatient record audit experience.
• Solid understanding of MS-DRG and APR-DRG grouping, including CC/MCC impact on reimbursement.
• Ability to apply ICD-10-CM and ICD-10-PCS guidelines to diagnosis selection and coding.
• Experience using encoder and grouper tools.
• Self-directed work style with ability to meet productivity and quality goals remotely.

Responsibilities

• Examine inpatient records to confirm principal and secondary diagnoses, procedures, and DRG accuracy.
• Assess whether complications and comorbidities are supported by labs, vitals, imaging, meds, and physician notes.
• Determine clinical validity of high impact conditions under APR-DRG.
• Evaluate how documented conditions affect severity of illness and mortality risk.
• Apply ICD guidelines and CMS requirements to determinations.
• Recommend DRG changes when records do not support billing; document rationale clearly.
• Write audit rationales that are concise and defendable in appeals.
• Assist with appeal responses by researching criteria and guidance.
• Meet targets for productivity, accuracy, and turnaround time.
• Share knowledge with peers and support onboarding of new staff.
• Stay current on annual coding updates and reimbursement rules.

Skills

Active RN license

Acute care nursing

DRG validation experience

Remote work capability

Tools

Encoder tools

Grouper tools

Job description

We are seeking a remote DRG Clinical Validation Nurse to join an established inpatient clinical review team. In this role, you will examine inpatient records from admission through discharge to confirm that coded diagnoses, procedures, and DRG assignments accurately reflect the patient's clinical picture. This position blends acute care nursing expertise with inpatient coding and reimbursement knowledge, and it plays a direct role in ensuring hospital stays are paid accurately. This is a full time, direct hire opportunity and is fully remote.

This role is well suited for a registered nurse who has already built a foundation in DRG validation, clinical validation, or inpatient audit and is looking for a stable, long term remote position. The ideal candidate is clinically sharp, detail driven, and able to translate complex medical documentation into clear, well supported determinations.

Responsibilities

• Examine inpatient records to confirm the principal diagnosis, secondary diagnoses, procedures, and resulting DRG are accurate and properly sequenced
• Assess whether complications, comorbidities, and major complications are backed by labs, vital signs, imaging, medications, and physician documentation
• Determine the clinical validity of high impact conditions such as sepsis, acute kidney injury, acute respiratory failure, encephalopathy, and malnutrition
• Evaluate how documented conditions affect severity of illness and risk of mortality under APR-DRG
• Apply official ICD-10-CM and ICD-10-PCS guidelines, Coding Clinic, and CMS requirements to every determination
• Recommend DRG changes when the record does not support the billed assignment and record the reasoning clearly
• Write audit rationales that are concise, clinically grounded, and able to hold up under provider appeal
• Assist with appeal responses by researching clinical criteria and coding guidance as needed
• Meet defined targets for productivity, accuracy, and turnaround time
• Share knowledge with peers and support the onboarding of newer team members
• Keep current on annual coding updates, clinical criteria changes, and reimbursement rules
• Protect patient health information in accordance with HIPAA requirements

Qualifications

• Active, unrestricted compact (multistate) Registered Nurse license
• 3+ years of acute care nursing in ICU, emergency department, step down, or another high acuity hospital setting
• 2+ years of hands on experience in inpatient DRG validation, clinical validation, or inpatient record audit
• Solid understanding of MS-DRG and APR-DRG grouping, including how CC and MCC capture and severity levels drive reimbursement
• Ability to apply ICD-10-CM and ICD-10-PCS guidelines to diagnosis selection, procedure coding, and sequencing
• Experience using encoder and grouper tools
• Self directed work style with a proven ability to meet production and quality goals while working remotely

Preferred Qualifications

• Credential such as CCS, CIC, CDIP, CCDS, RHIA, or RHIT
• DRG validation experience on the payer side or with a payment review organization
• Background in clinical appeals, rebuttal writing, or second level quality review
• Working familiarity with InterQual or MCG criteria
• Experience training or mentoring other auditors

Schedule

• Full time, direct hire
• Monday through Friday, standard daytime business hours
• Fully remote
• Reliable high speed internet and a private, HIPAA compliant home workspace required

Salary Range

The salary range for this position is approximately $70,000 to $90,000 annually ($33.65 to $43.27 per hour), based on experience and qualifications.

Interview Process

Selected candidates will participate in a multi step interview process, including an initial screening with TalentLNX followed by interviews with department leadership.

Equal Opportunity Employer

TalentLNX is committed to equal employment opportunity and a diverse, inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by applicable federal, state, or local law.