Clinical Nurse Supervisor- Mississippi

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 Lead and oversee daily clinical operations for RNs and Certified Coding professionals, ensuring productivity, quality, compliance, and achievement of operational goals. Manage clinical claims review and processing activities, including medical necessity reviews, audits, reconsiderations, utilization management support, and resolution of complex DRG and OPPS claim issues. Ensure accurate, timely, and compliant claims processing in accordance with payer policies, CMS, Mississippi Medicaid, contractual requirements, and organizational standards. Provide oversight of CPT, HCPCS, and related coding functions, ensuring coding accuracy, regulatory compliance, quality assurance, and resolution of coding and reimbursement issues. Monitor performance metrics, SLAs, claims inventory, coding accuracy, staff productivity, turnaround times, and financial outcomes; develop reports and dashboards for leadership. Analyze operational and clinical data to identify trends, denied-claim root causes, provider education opportunities, and process improvement initiatives. Lead quality, compliance, and risk management activities, including HIPAA compliance, audits, accreditation support, corrective action plans, and continuous process improvement. Collaborate with internal stakeholders, providers, clients, and operational teams to improve efficiency, quality outcomes, and member/provider satisfaction while supporting departmental and organizational strategic goals.

What we're looking for Associate Degree in Nursing (ADN) required; Bachelor's degree in Nursing, Healthcare Administration, Business Administration, or related field preferred. Active, unrestricted RN license required (Mississippi or Compact State/NLC license). Current coding certification required: RHIA, RHIT, CCS, CIC, CCDS, or CPC. 5+ years of experience reviewing and adjudicating clinical or medical claims. 3+ years of experience with DRG (Inpatient) and OPPS/APC (Outpatient) payment methodologies. Experience with CPT, HCPCS, and ICD coding, coding compliance, and reimbursement systems. Knowledge of Medicare, Medicaid, regulatory requirements, and InterQual or Milliman guidelines. Demonstrated ability to apply clinical judgment and make clinical determinations. 3+ years of leadership experience managing clinical teams and driving performance. Strong skills in clinical operations, claims adjudication, compliance, audit readiness, process improvement, data analysis, and team development.

What you should expect in this role Candidates must reside in Mississippi. This is a full-time, exempt, hybrid position. Employees are required to work onsite to our Jackson, MS office during the first 90 days of employment. After the onboarding period, the position may transition to a work-from-home arrangement, with occasional onsite attendance required based on business needs. Applications will be accepted through September 21, 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 401(k) employer match, comprehensive health benefits, 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.