Clinical Policy Specialist - Itemized Bill Review (Remote)
- Salary
- $86.8K–$124KUSD per year
- Hiring from
- United States
- Work type
- Remote
- Posted
- Sep 23, 2026
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
Your role in our mission
Essential Job Functions
- Assesses the physical and psychosocial health status of employees through collection of health data such as, complete history taking, physical examination, initiation and interpretation of laboratory tests and initiation of other diagnostic tests as determined by protocol.
- Identifies problems based upon examination findings to determine the need for immediate nursing intervention, consultation and referral to other health team members.
- Monitors and manages the care of stabilized chronic conditions under direction of upper management or personal physician; ensures that appropriate medical assistance is available, when needed. May train employees in the self-management of health problems.
- Investigates quality and quantity of provided health care to determine adherence with company and governmental policies. Provides nursing care for complex occupational illnesses and injuries at various worksites including emergency care and referrals.
- Maintains health related documentation such as employee medical records. Tracks and records exposure to hazardous environments or chemicals and common injuries to ensure prevention of future occurrence. Provides counseling on routine health subjects and referrals to other health care professionals.
- Participates in decisions regarding the formulation of policies, procedures and protocols for the management of specific health problems; ensures that medical issues related to employee health and occupational environment are addressed in a timely manner.
- Interfaces with line management, safety and industrial hygienists, and human resources personnel regarding resolution of pending medical claims or cases related to on-site accidents or injuries, to ensure resolution in a timely manner.
- Plans and evaluates health education programs. Establishes, maintains, and reviews nursing record keeping systems to ensure confidentiality and adherence to legal requirements.
- Supervises Guides less experienced staff in the delivery of health care consistent with nursing practice standards and established company policies to ensure that appropriate care is provided in a timely manner.
Basic Qualifications
- Bachelor's degree or equivalent combination of education and experience
- Bachelor's degree in nursing or related field preferred
- Nine or more years of nursing experience
- Experience working with medical procedures and techniques
- Experience working with emergency medical techniques such as cardiac pulmonary resuscitation (CPR) and first aid
- Experience working with company facilities
- Experience working with case management practices
- Experience working with providing health education programs
Other Qualifications
- Communication skills
- Organization and time management skills
- Leadership skills to guide and mentor the work of less experienced personnel
- Interpersonal skills
- Problem solving and analytical skills
- Ability to work in a team environment
- Ability to keep sensitive and confidential material private
- Willingness to travel
Work Environment
- Office environment
What we're looking for
What you should expect in this role
The pay range for this position is $86,800.00 - $124,000.00 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.