Clinical Nurse Supervisor - Hybrid - Ridgeland, MS

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

As a Clinical Nurse Supervisor at Gainwell, you will lead a team of Registered Nurses and medical coding professionals responsible for clinical claims review, medical necessity determinations, and coding accuracy within Medicaid healthcare operations.

In this role, you will oversee daily clinical review activities, ensure compliance with federal and state regulations, monitor team performance, and drive improvements in quality, productivity, and operational efficiency.

The ideal candidate combines strong clinical nursing expertise with knowledge of medical coding, healthcare reimbursement, and experience supervising clinical or coding teams.

Your role in our mission

• Supervise, coach, and develop a team of Registered Nurses and medical coding professionals responsible for clinical claims review and coding operations.

• Oversee clinical claims reviews, medical necessity determinations, and coding activities to ensure accuracy, timeliness, and regulatory compliance.

• Monitor team productivity, quality, turnaround times, and service-level performance to ensure operational goals are achieved.

• Provide clinical guidance and support for complex claims, coding discrepancies, medical necessity reviews, and escalated cases.

• Ensure adherence to Medicaid, Medicare, CMS, HIPAA, and applicable federal and state regulatory requirements.

• Review clinical documentation, coding practices, and reimbursement methodologies to identify errors, trends, and opportunities for improvement.

• Collaborate with Medical Directors, Claims Operations, Provider Relations, coding specialists, and other business partners to resolve complex clinical and operational issues.

• Conduct quality reviews, support internal and external audits, and implement corrective action plans when necessary.

• Identify opportunities to streamline workflows, improve clinical review accuracy, and enhance operational efficiency.

• Support employee training, performance evaluations, coaching, and professional development to build a high-performing team.

What we're looking for

• Active, unrestricted Registered Nurse (RN) license.

• Experience in clinical claims review, utilization review, medical necessity determinations, or healthcare reimbursement operations.

• Knowledge of Diagnosis-Related Groups (DRG), Outpatient Prospective Payment System (OPPS), and Ambulatory Payment Classifications (APC).

• Familiarity with InterQual and/or Milliman Care Guidelines (MCG) used in medical necessity and utilization reviews.

• Active medical coding certification, such as RHIA, RHIT, CCS, CIC, CCDS, or CPC.

• Working knowledge of CPT, HCPCS, and ICD coding systems, coding compliance, and medical documentation requirements.

• Experience supervising, coaching, or leading clinical nursing and/or medical coding teams.

• Understanding of Medicaid, Medicare, CMS regulations, HIPAA requirements, and healthcare payer guidelines.

• Ability to analyze operational performance metrics, identify process gaps, and implement effective solutions.

• Strong leadership, communication, organizational, and problem-solving skills.

• Ability to manage competing priorities and maintain accuracy and compliance in a fast-paced healthcare environment.

What you should expect in this role

• Work Location: 381 Highland Colony Pkwy, Ridgeland, MS 39157.

• Work Arrangement: Hybrid, following successful completion of the initial onsite onboarding and training period.

• First 90 Days: Candidates must be available to work onsite at the Ridgeland, Mississippi office during their first 90 days for onboarding, training, and operational integration.

• Hybrid Eligibility: Following successful completion of the initial 90-day period, employees may transition to a hybrid work arrangement based on performance, operational requirements, and business needs.

• Leadership Responsibilities: Supervise Registered Nurses and medical coding professionals supporting clinical claims review and healthcare reimbursement operations.

• Collaboration: Work closely with Medical Directors, Claims Operations, Provider Relations, and other clinical and operational leadership teams.

• Performance Expectations: Maintain a strong focus on clinical accuracy, regulatory compliance, productivity, service quality, and continuous improvement.

Applications will be accepted until December 4, 2026.

The pay range for this position is $61,500.00 - $87,900.00 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. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.