Senior Nurse Reviewer- Remote

Gainwell Technologies; Texas; Remote; USD 78.000 - 99.000; Vollzeit

Benefits dieser Stelle

401(k) employer match

Comprehensive health benefits

Generous vacation policy

Educational assistance

Zusammenfassung

Gainwell Technologies is seeking a Senior Nurse Reviewer for a remote, home-based role across the continental US. You will review medical records, UB-04 forms and itemized statements to ensure billing accuracy, compliance and appropriate care levels as part of a fast-paced production team.

The role requires an active RN license in the US and 5+ years in inpatient settings, plus at least 1 year of itemized bill review and 3+ years of utilization review or claims auditing.

Qualifikationen

• RN license (US) required to practice and be in good standing.
• 5+ years of inpatient hospital clinical experience.
• 1+ year itemized bill review experience.
• 3+ years utilization review or claims auditing experience preferred.
• Experience with CPT, ICD-10, HCPCS coding guidelines.
• Experience using MCG or InterQual criteria preferred.

Aufgaben

• Perform in-depth review of medical claims using UB-04 and itemized statements to verify line-item charges.
• Verify accuracy of itemized charges per client policy and industry standards.
• Conduct level of care and utilization review by analyzing medical records against criteria.
• Apply critical thinking to determine if documentation supports services while meeting production goals.
• Assist management with training new reviewers, including daily monitoring and feedback.
• Maintain up-to-date knowledge of clinical criteria guidelines and complete CEUs for RN license.
• Attend trainings and meetings to enhance skills in clinical policies and regulations.
• Cross-train to review multiple claim types to meet client needs.

Kenntnisse

CPT/ICD-10/HCPCS knowledge

MCG/InterQual criteria

Ability to multi-task

Inpatient hospital experience

Ausbildung

Active US RN license

Compact multistate RN license (NLC)

Tools

CPT/ICD-10/HCPCS guidelines

Jobbeschreibung

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Senior Nurse Reviewer- Remote

Date: Oct 9, 2026

Location:

Any city, TX, US, 99999

Work Mode: Virtual (Exception only)

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary

We are seeking a talented individual for a Senior Nurse Reviewer to perform reviews of medical records, healthcare claims, itemized medical bill, and UB-04 forms to ensure accuracy, compliance, and proper billing practices. This position requires clinical review expertise, as well as itemized bill review experience.

Your role in our mission

• Perform an in-depth review of medical claims utilizing the UB-04 and detailed itemized statement to ensure the validity of line-item charges.
• Verify accuracy of the itemized charges in accordance with client policy and industry standards.
• Perform level of care and utilization review by analyzing medical records and comparing against criteria to determine appropriateness and reasonableness of care.
• Apply critical thinking and decision making skills to determine if the medical record documentation supports the need for service while maintaining production goals and quality standards.
• Assists management with training new reviewers to include daily monitoring, mentoring, feedback and education.
• Maintains current knowledge of clinical criteria guidelines and/or coding guidelines; successfully completes required CEUs to maintain RN license.
• Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.
• Actively cross-trains to perform reviews of multiple claim types to provide a flexible workforce to meet client needs.

What we're looking for

• Active, Unrestricted RN license from the United States and in the primary home residency, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), required
• 5+ years clinical experience in an inpatient hospital setting required
• 1+ year itemized bill review experience required
• 3+ years 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 multi-task in a fast-paced production environment.

What you should expect in this role

• Home based position and you must have a work location within the continental US
• This position requires that you provide high speed internet connection and a work environment free from distractions
• Ability to work during normal business hours as this position requires frequent interactions with the team and other departments within the company
• May be required to work extended hours for special business needs
• May be required to travel at least 10% of time based on business needs

Will accept application until October 23, 2026.

The pay range for this position is$78,000.00-$99,200.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.