Clinical Review Nurse

About the role

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.

Responsibilities

• 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.
• 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 in the U.S. while making a tangible difference.
• Competitive Salary: $ 65 ,000-$ 8 5,000 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
• 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.

Benefits

Additional Information

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!

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