Gainwell Technologies
Nurse Reviewer - Remote North Carolina
50k - 70k USD
Remote
Full Time
#Critical Thinking
#Decision Making Processes
#Nurse
#Registered Nurse
#Remote Support Specialist
Gainwell Technologies is looking for a Nurse Reviewer - Remote North Carolina
Full TimeMid-LevelRemoteUnited StatesCritical ThinkingDecision Making ProcessesNurseRegistered NurseRemote Support SpecialistEnglishRemote work
50k - 70k USD per year
At Gainwell, we leverage technology to solve complex healthcare challenges and improve the well-being of vulnerable populations. We are looking for a dedicated Nurse Reviewer based in North Carolina to join our team and apply clinical expertise to our utilization review processes.
Responsibilities
- Evaluate medical records against clinical criteria to determine the appropriateness and necessity of care.
- Apply critical thinking and decision making processes to document findings and justify clinical determinations.
- Manage prior authorizations, precertifications, and retrospective reviews while meeting quality and production standards.
- Initiate referrals to physician consultants and ensure all denials are processed with detailed rationales within contractual deadlines.
- Mentor and train new team members while actively participating in process improvement initiatives.
- Maintain current knowledge of clinical policies and regulatory requirements through ongoing training and education.
- Cross-train across multiple claim types to support a flexible and responsive workforce.
Must-haves
- Active and unrestricted Registered Nurse (RN) license.
- Minimum of 5 years of clinical experience in an inpatient hospital setting.
- At least 2 years of experience in utilization review or claims auditing.
- Proficiency in using Milliman or InterQual criteria.
- Strong computer skills including Microsoft Office suite and internet browsers.
- Must be a resident of North Carolina with a reliable broadband internet connection.
Benefits
The salary range for this position is $50,000 to $70,000 per year.
- Full-time remote work flexibility.
- Comprehensive health benefits.
- Generous flexible vacation policy.
- 401(k) employer match.
- Educational assistance and access to leadership and technical development academies.
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