Clinical Review Nurse

Other Jobs To Apply

No other job posts for this day.

This a Full Remote job, the offer is available from: Anywhere

Welcome! We’re excited you’re exploring opportunities with us. Below you’ll find details about the role, the impact you can make, and what we’re looking for in an ideal candidate. We’re passionate about building a team that shares our values and brings diverse perspectives to help us grow and succeed together.

Clinical Review Nurse (Remote) 

Join Our Team at Ternium – A Leading Advocate in Healthcare Revenue Solutions! 

Do you want to use your expertise to make a meaningful impact in the healthcare industry? If so, Ternium is looking for you! 

Who We Are: 
At Ternium, we specialize in resolving complex healthcare insurance claim denials and delays. Our mission is to empower hospitals and health systems by optimizing their revenue cycle, allowing them to focus on what matters most—patient care. With a dedicated team of professionals, we consistently deliver outstanding results, increasing net patient revenue, improving cash flow, and reducing operational costs while enhancing the patient experience. 

What You’ll Do: 
As a Clinical Review Nurse, you won’t just review charts—you’ll write compelling clinical arguments that help hospitals recover millions in lost revenue due to denied insurance claims. You’ll use your nursing knowledge, attention to detail, and love of documentation to make a real difference—without ever setting foot in a courtroom or hospital shift. 

This is a perfect role for nurses who: 

  • Want to step away from the bedside but still use their clinical skills. 
  • Love research, documentation, and writing. 
  • Want a fully remote, flexible role with meaningful impact. 
  • Are excited to grow with a fast-paced, mission-driven team. 

Key Responsibilities: 

  • Analyze denied insurance claims and complete medical records. 
  • Apply clinical reasoning, national criteria (InterQual/Milliman), and best practices to determine if appeals are justified. 
  • Draft persuasive, medically sound appeal letters that clearly support the need for treatment or services. 
  • Collaborate with our legal team to ensure appeals are compelling and complete. 
  • Stay informed on healthcare regulations, payer trends, and clinical updates. 

What You Bring to the Table: 

  • RN License (required) 
  • 5+ years of acute hospital experience (required) 
  • Certification in Case Management, Legal Nurse Consulting, or Coding is a plus. 
  • Possess knowledge and experience with national clinical criteria applied in case management including InterQual and Milliman standards 
  • Experience and knowledge of managed care contracts, account receivables and revenue cycle functions (preferred)  
  • Experience and success in medical record chart review and appealing managed care denials (preferred) 

Why Join Us? 

  • 100% Remote: Work from anywhere while making a tangible difference. 
  • Competitive Salary: $65,000–$85,000 per year (commensurate with experience). 
  • Robust Benefits Package: 401(k) with corporate match, comprehensive health, dental, and vision insurance. 
  • Work-Life Balance: Flexible schedule and paid time off. 
  • Career Growth: Access to professional development, mentorship, and upward mobility within a thriving company. 
  • Additional Perks: Life insurance and performance-based bonuses. 

A Culture of Inclusion & Opportunity 
Ternium is an equal opportunity employer that values diversity and inclusion. We do not discriminate based on age, race, disability, religion, gender, sexual orientation, gender identity, genetic information, marital status, veteran status, or any other protected characteristic. We are also committed to maintaining a supportive and harassment-free work environment. 

Ready to Elevate Your Career? 
If you’re looking for a fulfilling role where your experience in Nursing can drive real impact, apply today and become a valued member of the Ternium team! 

 

Thank you for considering a career with us! We encourage you to apply even if you don’t meet every requirement — we value passion, potential, and a willingness to learn. We look forward to reviewing your application and hopefully welcoming you to our team.

This offer from "Ternium Revenue Cycle Management" has been enriched by Jobgether.com and got a 82% flex score.
Back to blog

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...