Clinical Nurse Supervisor- Mississippi

Gainwell Technologies LLC•Any city, OH

1d•$65,200 - $93,100•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. Your role in our mission: Ensure accurate, timely, and compliant clinical claims decisions that support quality healthcare outcomes for members. Lead clinical and coding teams in delivering operational excellence, regulatory compliance, and high-quality service. Support the integrity of healthcare reimbursement processes through effective clinical review, coding oversight, and claims adjudication. Promote collaboration across clinical, operational, provider, and leadership teams to improve efficiency and resolve complex claim issues. Drive continuous improvement initiatives that enhance quality, productivity, compliance, and stakeholder satisfaction. Leverage clinical expertise and data-driven insights to support informed decision-making and responsible healthcare resource management. Foster a culture of accountability, integrity, innovation, and professional development aligned with organizational values and strategic goals. Contribute to the organization's mission by ensuring members receive appropriate, medically necessary services while maintaining compliance with federal, state, and payer requirements.

Requirements

Active, unrestricted RN license.
Experience in clinical claims review, medical necessity determinations, and healthcare reimbursement methodologies.
Knowledge of DRG, OPPS/APC payment methodologies, and InterQual and/or Milliman criteria.
Active coding certification (RHIA, RHIT, CCS, CIC, CCDS, or CPC).
Experience with CPT, HCPCS, and ICD coding principles, coding compliance, and audit processes.
Proven experience leading clinical and/or coding teams.
Strong knowledge of Medicare, Medicaid, CMS, HIPAA, and payer guidelines.
Excellent analytical, communication, and problem-solving skills.
Commitment to quality, compliance, operational excellence, and continuous improvement.

Responsibilities

Lead a team of Registered Nurses and coding professionals responsible for clinical claims review and coding operations.
Collaborate with Medical Directors, Claims Operations, Provider Relations, and leadership teams to resolve complex claim issues.
Monitor productivity, quality, compliance, and service-level performance metrics.
Support audits, regulatory reviews, and process improvement initiatives.
Work in a fast-paced environment focused on accuracy, quality, operational efficiency, and member and provider satisfaction.