Nurse Reviewer Associate- Remote

Gainwell is seeking a Nurse Reviewer Associate to perform clinical reviews to determine whether medical record documentation supports the need for a service, based on clinical criteria, coverage policies, and utilization and practice guidelines. The role involves accessing proprietary systems, accurately documenting findings, and providing policy and regulatory support for determinations.

Requirements

• Active, unrestricted RN licensure from the United States and in your state of primary residence
• 3+ years of clinical experience in an inpatient hospital setting
• 1+ years of experience in utilization review or claims auditing
• Experience using Milliman or InterQual criteria is preferred
• Demonstrated proficiency in computer skills, including Microsoft Windows, Outlook, Excel, Word, PowerPoint, internet browsers, and typing

Benefits

• Generous, flexible vacation policy
• 401(k) employer match
• Comprehensive health benefits
• Educational assistance