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Remote Rn Case Review Jobs in Georgetown, TX (NOW HIRING)

Valeris

Executive Case Manager (Remote)

Austin, TX · Remote

$19.75 - $25.50/hr

Coordinates nurse teach with nurse educators, as applicable to program * Supports adherence ... Case Manager). * Strong understanding of medical terminology, coding systems (ICD-10, CPT, HCPCS ...

PharmaCord LLC

Executive Case Manager (Remote)

Austin, TX · On-site +1

$19.75 - $25.50/hr

Coordinates nurse teach with nurse educators, as applicable to program * Supports adherence ... Case Manager). * Strong understanding of medical terminology, coding systems (ICD-10, CPT, HCPCS ...

LOGIC Health Management

Chronic Care Coordinator

Austin, TX · On-site +1

$19 - $25.75/hr

Active credential or licensure as an MA, CNA, CMA, LPN/LVN, or RN preferred Benefits Contract ... Remote position * Training provided on internal workflows, escalation protocols, and documentation ...

LOGIC Health Management

Chronic Care Coordinator

Austin, TX · Remote

$19.75 - $26.50/hr

Active credential or licensure as an MA, CNA, CMA, LPN/LVN, or RN preferred Benefits Contract ... Remote position * Training provided on internal workflows, escalation protocols, and documentation ...

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How much do remote rn case review jobs pay per hour?

As of May 30, 2026, the average hourly pay for remote rn case review in Georgetown, TX is $44.16, according to ZipRecruiter salary data. Most workers in this role earn between $32.84 and $53.37 per hour, depending on experience, location, and employer.

What is the difference between Remote Rn Case Review vs Remote Rn Utilization Review?

AspectRemote Rn Case ReviewRemote Rn Utilization Review
CredentialsRegistered Nurse (RN), licensure, case review certificationsRegistered Nurse (RN), licensure, utilization review certifications
Work EnvironmentRemote, healthcare settings, insurance companiesRemote, healthcare settings, insurance companies
Employer & IndustryHospitals, insurance firms, healthcare providersInsurance companies, healthcare management organizations

Remote Rn Case Review and Remote Rn Utilization Review roles both involve remote nursing work within the healthcare and insurance industries. While they share similar credentials and work environments, case review focuses on evaluating individual patient cases, whereas utilization review assesses the necessity and appropriateness of healthcare services. Understanding these distinctions helps job seekers identify the right role based on their skills and career goals.

What are the most commonly searched types of Rn Case Review jobs in Georgetown, TX? The most popular types of Rn Case Review jobs in Georgetown, TX are:
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Remote Rn Case Review jobs near you
Clinical DRG Auditor- Remote

Clinical DRG Auditor- Remote

Gainwell Technologies LLC

Austin, TX • Remote

$90K - $105K/yr

Other

Medical, Life, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Gainwell Technologies rating

7.7

Company rating: 7.7 out of 10

Based on 72 frontline employees who took The Breakroom Quiz

103rd of 183 rated software companies

Job description

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.
Sign-on bonuses are available for highly qualified candidates.
Summary
We are seeking a talented individual for aClinical DRG Auditor who is responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation to validate the conditions that were documented in the medical record, the ICD-10-CM/PCS code assignments and determine the accuracy of DRG assignment that is clinically supported as defined by review methodologies specific to the contract for which review services are being provided. This involves accessing proprietary systems to audit medical records, accurately documenting findings and providing policy/regulatory support for determination. The candidate must have extensive clinical experience with a background in auditing medical records with a high level of understanding payment methodologies including MS-DRG, AP-DRG and APR-DRG.
What you will do
  • Performs audits of medical record documentation to determine the accuracy of principal and secondary diagnosis (including MCC & CC) and procedure codes. Adheres to official coding guidelines, coding clinics and regulatory guidelines and mandates. Draws on advanced ICD-10 coding expertise and clinical knowledge to substantiate conclusions. Utilizes HMS proprietary auditing systems with a high level of proficiency to document audit determinations and rationale. Applies clinical review judgment to make coding validation determinations including sequencing ICD-10-CM, ICD-10-PCS procedural codes for inpatient claims.
  • Consistently achieves productivity and quality performance standards established by management.
  • Assists management with training new Coders or Clinical DRG Auditors to include daily monitoring, mentoring, feedback and education.
  • Maintains current knowledge of coding guidelines and successfully completes required CEUs to maintain RN license and coding certification
  • Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.

What we are looking for
  • Active, unrestricted RN licensure from the United States and in the state of primary home residency, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), required
  • At least one of the following Coding Certifications is required and is to be maintained as a condition of employment: RHIA, RHIT, CCS, CIC, CCDS or CPC
  • 3+ years clinical experience in an inpatient hospital setting required
  • 2+ years of MS DRG/APR DRG coding or auditing experience with expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies
  • Expert knowledge of ICD -10-CM coding including but not limited to; expert knowledge of principal diagnosis selection, complications/comorbidities (CCs) and major complications/comorbidities (MCCs), and conditions that impact severity of illness (SOI) and risk of mortality (ROM)
  • Expert knowledge of ICD-10-PCS coding methodologies, code sequencing, and discharge disposition in accordance with CMS requirements, Official Guidelines for Coding and Reporting, and Coding Clinic guidance.
  • Demonstrated ability to apply clinical review judgment to make clinical determinations
  • Demonstrated proficiency in computer skills and typing, i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers and in virtual meeting tools i.e., Microsoft Teams, Zoom, etc.

What you should expect in this role
  • Remote within the U.S.
  • May be required to work extended hours for special business needs
  • Travel: 0-10% of the time, depending on business needs.

Applications for this posting will be accepted until May 29, 2026.
The pay range for this position is $90,000.00 - $105,000.00 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.

What Gainwell Technologies employees say

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Benefits

Hours and flexibility

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About Gainwell Technologies

Sourced by ZipRecruiter

With Health and Cost outcomes that pierce Inequities and Impact Economies, the success of our Nation’s Federal Medicaid program is inextricably tied to the Prosperity of Communities, States and the Nation as a whole. We think that deserves Respect and a Commitment from Innovators who can help those who operate within and around health and human services evolve to meet their goals. At Gainwell, that’s our Sole focus. Built across more than Five Decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet Agencies, Health plans and MCOs where they are on their modernization journeys and propel them into the future of Healthcare. Equally important to our Expanding Technologies and Results. We bring ideas that bring policies to life.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Irving, TX, US

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