Machinify

1 month ago

Medical Review Nurse - Clinical Validation

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 2 hours agoStatus: Live

Job Summary

Lead medical claims audit reviews for inpatient settings, applying medical review guidelines (e.g., MCG and InterQual), and accurate coding (ICD-9/ICD-10, CPT-4/HCPCS). Work remotely as part of a multi-location team, documenting findings, supporting appeals when needed, and staying current on regulatory changes to optimize client outcomes.

Location: United States

Workplace: Remote

Employment Type: Full time

Job Function: Healthcare (Clinical, Medical, Wellness)

Key Responsibilities

•Auditing inpatient claims for medically appropriate services using applicable guidelines and rules
•Documenting all findings with reference to policies and rules
•Generating letters articulating audit findings
•Supporting findings during the appeals process when requested
•Cross-training across clinical departments and collaborating with the audit team to identify vulnerabilities

Key Requirements

•Inpatient claims auditing, quality assurance or recovery auditing experience of 2 years or more
•An associate or bachelor’s degree in nursing (active/unrestricted RN license)
•Experience with ICD-9, ICD-10, CPT-4 or HCPCS coding
•Experience with utilization management systems or clinical decision-making tools such as MCG or InterQual
•Certification: CCDS, CDIP, CCS, or CIC

Experience:2+ yearsHealthcare

Education:Bachelor's in Nursing

Skills:CommunicationAttention to detailAnalytical thinkingTime managementIndependent work

Certifications:CCDSCDIPCCSCIC

Languages:English

Tech Stack:MCGInterQualICD-9ICD-10CPT-4HCPCSSharePointSlackOutlook

Company Brief

Machinify

Provides AI-driven predictive maintenance and asset-monitoring solutions for manufacturing and industrial operations, using IoT sensor data and machine learning to reduce downtime, optimize performance, and extend equipment life.

Industry: Industrial Automation

Website

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Machinify

1 month ago

Medical Review Nurse - Clinical Validation

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 2 hours agoStatus: Live

Job Summary

Location: United States

Workplace: Remote

Employment Type: Full time

Job Function: Healthcare (Clinical, Medical, Wellness)

Key Responsibilities

•Auditing inpatient claims for medically appropriate services using applicable guidelines and rules
•Documenting all findings with reference to policies and rules
•Generating letters articulating audit findings
•Supporting findings during the appeals process when requested
•Cross-training across clinical departments and collaborating with the audit team to identify vulnerabilities

Key Requirements

•Inpatient claims auditing, quality assurance or recovery auditing experience of 2 years or more
•An associate or bachelor’s degree in nursing (active/unrestricted RN license)
•Experience with ICD-9, ICD-10, CPT-4 or HCPCS coding
•Experience with utilization management systems or clinical decision-making tools such as MCG or InterQual
•Certification: CCDS, CDIP, CCS, or CIC

Experience:2+ yearsHealthcare

Education:Bachelor's in Nursing

Skills:CommunicationAttention to detailAnalytical thinkingTime managementIndependent work

Certifications:CCDSCDIPCCSCIC

Languages:English

Tech Stack:MCGInterQualICD-9ICD-10CPT-4HCPCSSharePointSlackOutlook

Company Brief

Machinify

Industry: Industrial Automation

Website