About the job
Clinical Review Nurse – Fully Remote
Schedule: Monday–Friday, 8:00 AM–5:00 PM
Location: Fully Remote
Training: 8:00 AM–5:00 PM Central Time during initial training
Position Overview
We are seeking experienced Registered Nurses (RNs) with a strong high-acuity clinical background who are interested in transitioning from bedside nursing into medical bill auditing and clinical review.
This is an excellent opportunity for an RN with recent experience in the Operating Room, ICU, NICU, Emergency Department, Orthopedics/Implants, or Interventional Radiology who wants to apply their clinical expertise in a new setting. Prior medical audit experience is a plus, but not required—comprehensive training will be provided.
Successful candidates will be analytical, detail-oriented, highly organized, and committed to learning the medical billing audit process while contributing positively to a collaborative team culture.
Key Responsibilities
- Collect and analyze supporting clinical and billing data to determine the accuracy and appropriateness of billed services.
- Perform itemization reviews for designated clients.
- Apply knowledge of surgical implants and high-acuity procedures during clinical reviews.
- Document review activities, findings, and final conclusions accurately in the designated computer system.
- Maintain compliance with HIPAA regulations and organizational policies.
- Meet department productivity, quality, accuracy, and performance expectations.
- Collaborate effectively with leadership and team members to resolve complex review issues.
- Apply analytical and critical-thinking skills to identify discrepancies and support accurate billing decisions.
- Maintain proficiency with Microsoft Office, including Excel, Outlook, and Teams.
Required Qualifications
- Current, unrestricted Registered Nurse (RN) license in the state of employment.
- 5+ years of recent RN experience in one or more of the following high-acuity settings:
- Operating Room (OR)
- Intensive Care Unit (ICU)
- Emergency Department (ED/ER)
- Neonatal Intensive Care Unit (NICU)
- Orthopedics with surgical implants
- Interventional Radiology (IR)
- Associate Degree in Nursing (ADN) or higher.
- Strong clinical judgment, analytical ability, and attention to detail.
- Ability to work independently while contributing effectively within a remote team environment.
- Willingness and ability to learn medical bill auditing and itemization review processes.
Prior audit experience is not required. Comprehensive training will be provided to candidates with the right clinical background and a strong willingness to learn.
Why Join Us?
- 100% remote position
- Monday–Friday schedule
- Comprehensive training provided
- Opportunity to transition from high-acuity clinical nursing into medical bill auditing
- Opportunity to leverage your clinical expertise in a new career path
- Collaborative, team-oriented culture
If you’re an experienced high-acuity RN ready to take your clinical knowledge into the world of medical bill auditing, we’d love to hear from you!