Clinical Nurse Supervisor- Mississippi

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development. Summary 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. What we're looking for 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. What you should expect in this role Hybrid position based in Mississippi. Candidates must be willing to work onsite in the Mississippi office during the first 90 days for onboarding and training. Hybrid work eligibility begins following successful completion of the onboarding period, subject to business needs. 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. Will accept applications until October 30, 2026. The pay range for this position is$85,000.00-$100,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities. We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits. #J-18808-Ljbffr