Remote DRG Quality Advisor Nurse

Gainwell Technologies; Missouri; Remote; USD 90,000 - 110,000; Full time

Job summary

Gainwell Technologies is seeking a DRG Quality Advisor Nurse for a remote role within the continental United States. The position focuses on QA audits, DRG validation, coding audits, and ensuring compliance with clinical and coding guidelines.

You will leverage RN licensure, MS-DRG/APR-DRG knowledge, and ICD-10-CM/PCS expertise to drive quality outcomes, mentor reviewers, and support process improvements while maintaining regulatory standards.

Qualifications

• RN licensure active in the United States with primary state residency.
• 3+ years MS-DRG/APR-DRG coding or auditing experience with expert knowledge of ICD-10 guidelines.
• Expert knowledge of ICD-10-CM and ICD-10-PCS coding methodologies.
• Ability to apply clinical review judgment to make determinations.

Responsibilities

• Perform QA checks on final review work for complex clinical claims and DRG validation of medical records.
• Review data and documentation using approved clinical review methodologies and coding guidelines.
• Document audit findings, rationales, and evidence clearly in systems.
• Support onboarding and mentoring of new reviewers and coders.
• Maintain current knowledge of coding guidelines and CEUs for licensure.

Job description

Gainwell Technologies is seeking a DRG Quality Advisor Nurse for a remote role within the continental United States. The position focuses on QA audits, DRG validation, coding audits, and ensuring compliance with clinical and coding guidelines.

You will leverage RN licensure, MS-DRG/APR-DRG knowledge, and ICD-10-CM/PCS expertise to drive quality outcomes, mentor reviewers, and support process improvements while maintaining regulatory standards.