[Hiring] Clinical Review Nurse @Ternium Revenue Cycle Management

Role Description

As a Clinical Review Nurse, you won’t just review charts—you’ll write compelling clinical arguments that help hospitals recover millions in lost revenue due to denied insurance claims. You’ll use your nursing knowledge, attention to detail, and love of documentation to make a real difference—without ever setting foot in a courtroom or hospital shift.

• Analyze denied insurance claims and complete medical records.
• Apply clinical reasoning, national criteria (InterQual/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 our legal team to ensure appeals are compelling and complete.
• Stay informed on healthcare regulations, payer trends, and clinical updates.

Qualifications

• RN License (required)
• 5+ years of acute hospital experience (required)
• Certification in Case Management, Legal Nurse Consulting, or Coding is a plus.
• Possess knowledge and experience with national clinical criteria applied in case management including InterQual 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).

Benefits

• 100% Remote: Work from anywhere in the U.S. 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.