RN Clinical Claim Review Manager

Job Summary

Leading a team in clinical reviews, the remote SSBV Clinical Claim Review Nurse Manager will manage administrative short-stay inpatient hospital reviews, support claim assignments, and provide training to Nurse Auditors while ensuring adherence to guidelines and quality assurance.

Key responsibilities

• Manage a team responsible for administrative short-stay inpatient hospital reviews according to federal, state, and client-specific requirements
• Support the Assistant Director with claim assignments, workflow coordination, and inventory management
• Provide education and training for new SSBV Nurse Auditors and maintain training materials

Required qualifications

• Active, unrestricted RN license
• 5+ years of RN experience, including inpatient or acute care settings
• 5+ years of clinical documentation experience
• Leadership or supervisory experience
• Solid experience reviewing medical records