We are seeking a Clinical Review Nurse to support itemized billing and documentation review within an established healthcare organization. This fully remote role focuses on applying critical care experience to evaluate billing accuracy and ensure alignment between patient care and submitted charges.
This opportunity is well suited for nurses with strong ICU, emergency department, operating room, trauma, or other high-acuity hospital-based experience who are ready to transition from direct patient care into a structured, analytical role.
Responsibilities
- Review medical records alongside itemized billing to ensure accuracy and completeness
- Validate that clinical care supports billed services and levels of care
- Identify discrepancies including overbilling, duplicate charges, and unsupported services
- Assess supply and equipment charges for alignment with care provided
- Apply critical care experience to evaluate intensity and appropriateness of services billed
- Document findings clearly for audit and review purposes
- Work independently while meeting productivity expectations
- Collaborate with internal clinical and audit teams
Qualifications (Required)
- Active RN license
- 3–5+ years of recent inpatient experience in high-acuity settings, including:
- Intensive Care Unit (ICU)
- Medical ICU (MICU)
- Surgical ICU (SICU)
- Cardiovascular ICU (CVICU)
- Neuro ICU
- Trauma ICU
- Operating Room (OR) within an inpatient hospital environment.
- Strong clinical documentation review skills
- Ability to work independently in a remote environment
Preferred Experience
- Experience in utilization review, clinical review, or audit
- Exposure to billing or reimbursement processes
- Familiarity with EMR systems
- Experience across multiple inpatient settings
Pay: $70,000.00 - $90,000.00 per year
Benefits:
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Application Question(s):
- How many years of bedside experience do you have in ICU or inpatient OR settings?
- Which unit(s) have you worked in? (Select all that apply or list): MICU, SICU, CVICU, Neuro ICU, Trauma ICU, OR, Other (please specify)
- Do you have any experience with hospital billing, charge review, or documentation tied to reimbursement or payment integrity? If yes, please briefly describe.
Work Location: Remote
