Ternium, LLC
Clinical Review Nurse
Remote
·
Full time
Company website
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.
Description
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:
- 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, national origin, citizenship status, 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!