Clinical Reviewer

3 weeks ago


Lafayette, Louisiana, United States Gainwell Technologies Full time

Gainwell Technologies is a leader in healthcare solutions, seeking a talented Nurse Reviewer for an Appeals and Hearings role. This full-time permanent regular salaried position offers upward career advancement opportunities.


The ideal candidate will have 5+ years of clinical experience or 5+ years of medical record coding experience, with active, unrestricted RN licensure from the United States. Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Professional Medical Auditor (CPMA) certification is preferred.


Job Responsibilities:

  • Reviews provider appeals and redeterminations using clinical and coding guidelines.
  • Analyzes and reviews appeal documentation to ensure accuracy and quality standards.
  • Prepares case files and case summaries for hearings and participates in virtual and on-site hearings.
  • Assists management with training new reviewers and maintains current knowledge of clinical criteria guidelines.
  • Actively cross-trains to perform reviews of multiple claim types.

A salary range of $85,000 - $115,000 per year is offered, with benefits including health (medical, dental, vision) and paid time off starting on day 1 of employment. The company match 401K and other benefits are available within months of starting.



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