Clinical Nurse Supervisor- Mississippi

Gainwell Technologies LLC•Any city, OH

7d•$85,000 - $100,000•Hybrid

About The Position

The Clinical Nurse Supervisor provides leadership and oversight for a team of nurses and coding professionals responsible for clinical claims processing and review activities. This role ensures the accurate, timely, and compliant adjudication of clinical claims in accordance with regulatory requirements, payer guidelines, and organizational standards. The Clinical Nurse Supervisor promotes operational excellence through effective team management, quality assurance, and process improvement initiatives. Serving as a key liaison among clinical staff, coding specialists, claims operations, providers, and organizational leadership, this position drives collaboration, efficiency, and overall departmental performance.

Requirements

Associate Degree in Nursing (ADN) required
Active, unrestricted RN license required (Mississippi or Compact State/NLC license).
Current coding certification required: RHIA, RHIT, CCS, CIC, CCDS, or CPC.
5+ years of experience reviewing and adjudicating clinical or medical claims.
3+ years of experience with DRG (Inpatient) and OPPS/APC (Outpatient) payment methodologies.
Experience with CPT, HCPCS, and ICD coding, coding compliance, and reimbursement systems.
Knowledge of Medicare, Medicaid, regulatory requirements, and InterQual or Milliman guidelines.
Demonstrated ability to apply clinical judgment and make clinical determinations.
3+ years of leadership experience managing clinical teams and driving performance.
Strong skills in clinical operations, claims adjudication, compliance, audit readiness, process improvement, data analysis, and team development.

Nice To Haves

Bachelor's degree in Nursing, Healthcare Administration, Business Administration, or related field preferred.

Responsibilities

Lead and oversee daily clinical operations for RNs and Certified Coding professionals, ensuring productivity, quality, compliance, and achievement of operational goals.
Manage clinical claims review and processing activities, including medical necessity reviews, audits, reconsiderations, utilization management support, and resolution of complex DRG and OPPS claim issues.
Ensure accurate, timely, and compliant claims processing in accordance with payer policies, CMS, Mississippi Medicaid, contractual requirements, and organizational standards.
Provide oversight of CPT, HCPCS, and related coding functions, ensuring coding accuracy, regulatory compliance, quality assurance, and resolution of coding and reimbursement issues.
Monitor performance metrics, SLAs, claims inventory, coding accuracy, staff productivity, turnaround times, and financial outcomes; develop reports and dashboards for leadership.
Analyze operational and clinical data to identify trends, denied-claim root causes, provider education opportunities, and process improvement initiatives.
Lead quality, compliance, and risk management activities, including HIPAA compliance, audits, accreditation support, corrective action plans, and continuous process improvement.
Collaborate with internal stakeholders, providers, clients, and operational teams to improve efficiency, quality outcomes, and member/provider satisfaction while supporting departmental and organizational strategic goals.