Lead Clinical Review Nurse - remote

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Senior Clinical Review Nurse - REMOTE. In this role, you will leverage your nursing expertise to make a significant impact in the healthcare sector. By focusing on denied insurance claims and crafting compelling clinical arguments, you will empower healthcare facilities to recover lost revenues.

This position allows you to work fully remotely, offering flexibility while contributing to the optimization of healthcare revenue cycles. Join a dedicated team that prioritizes patient care and strives to create a supportive environment for both employees and patients alike.

• Analyze denied insurance claims and complete medical records.
• Apply clinical reasoning, national criteria (Inter Qual/Milliman), and best practices to determine if appeals are justified.
• Draft persuasive, medically sound appeal letters that clearly support the need for treatment or services.
• Collaborate with the legal team to ensure appeals are compelling and complete.
• Stay informed on healthcare regulations, payer trends, and clinical updates.

• RN License (required)
• 5+ years of acute hospital experience (required)
• Certification in Case Management, Legal Nurse Consulting, or Coding is a plus.
• Knowledge and experience with national clinical criteria applied in case management including Inter Qual and Milliman standards.
• Experience and knowledge of managed care contracts, account receivables and revenue cycle functions (preferred).
• Experience and success in medical record chart review and appealing managed care denials (preferred).

• 100% Remote:
  Work from anywhere while making a tangible difference.
• Competitive Salary: $65,000–$85,000 per year (commensurate with experience).
• Robust Benefits Package: 401(k) with corporate match, comprehensive health, dental, and vision insurance.
• Work-Life Balance:
  Flexible schedule and paid time off.
• Career Growth:
  Access to professional development, mentorship, and upward mobility within a thriving company.
• Additional Perks:
  Life insurance and performance-based bonuses.

Why Apply Through Jobgether?

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Data Privacy Notice:
By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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