Senior Nurse Reviewer

Gainwell Technologies

. Perform in-depth reviews of medical claims using UB-04 forms and detailed itemized statements .

Posted 10/9/2026full-timeRemote • Texas • United StatesSenior💰 $78,000 - $99,200 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical claims review, including proficiency in UB-04 forms, CPT, ICD-10, and HCPCS coding guidelines. Possesses strong clinical experience and the ability to mentor and train new reviewers while maintaining high production and quality standards.

Highest-signal resume keywords

Active RN LicenseClinical Experience in Inpatient Hospital SettingItemized Bill Review ExperienceUtilization Review ExperienceMCG or InterQual Criteria Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Claims ReviewCPT CodingICD-10 CodingHCPCS CodingUtilization ReviewItemized Bill ReviewClinical Documentation AnalysisProduction Goal MaintenanceQuality Standards AdherenceMultitasking in Fast-Paced Environment

Soft Skills

MentoringFeedbackCollaborationCommunicationAdaptability

Certifications & Qualifications

Active RN LicenseNurse Licensure Compact (NLC) License

Industry Keywords

UB-04 FormsMedical RecordsLevel-of-Care ReviewUtilization Review CriteriaClinical GuidelinesCEUsClaims Auditing

About the role

Key responsibilities & impact

Perform in-depth reviews of medical claims using UB-04 forms and detailed itemized statements
Verify itemized charges according to client policy and industry standards
Conduct level-of-care and utilization reviews by analyzing medical records against criteria
Determine whether medical record documentation supports the need for services
Maintain production goals and quality standards
Assist management with training new reviewers through monitoring, mentoring, feedback, and education
Maintain current knowledge of clinical and coding guidelines and complete required CEUs
Attend training and scheduled meetings
Cross-train to review multiple claim types
Work with teams and company departments during normal business hours
Travel as required for business needs

Requirements

What you’ll need

Active, unrestricted RN license from the United States and in the primary home residency, or active compact multistate unrestricted RN license under the Nurse Licensure Compact (NLC)
5+ years of clinical experience in an inpatient hospital setting
1+ year of itemized bill review experience
3+ years of 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 multitask in a fast-paced production environment
Work location within the continental United States
High-speed internet connection and distraction-free work environment
Ability to work during normal business hours
Ability to attend training and scheduled meetings
Ability to travel at least 10% of the time if required by business needs

Benefits

Comp & perks

Flexible hours
Work-life balance
Continuous learning and career development
Flexible vacation policy
401(k) employer match
Comprehensive health benefits
Educational assistance
Leadership and technical development academies