Manager, Complex Clinical Review

For our client, we are seeking a Manager, Complex Clinical Review to join the team of a leader in the Technical Services space.

This role will oversee a clinical review function focused on complex bill review operations, team performance, and process quality within a remote, digital-first environment.

The manager will partner cross-functionally to coordinate workflows, support SLA attainment, and strengthen review standards through clear guidelines and disciplined execution.

The position is well suited for a clinically experienced leader who can translate audit findings into efficient operations and consistent communication across the organization.

Location: Remote - US based candidates only, no visa sponsorship available

Compensation: $115,000 – $130,000 annually

Responsibilities

• Oversee the complex clinical review team, ensuring performance and communication standards are met
• Analyze business processes through documentation and workflow assessments
• Evaluate programs for efficiency in clinical reviews
• Manage team assignments and coordinate cross-functional collaboration to meet SLAs
• Develop and oversee clinical review concepts and guidelines

Qualifications

• Current nursing license in good standing; coding certification is a plus
• 3+ years of supervisory experience in similar business environments, especially with remote teams
• 3+ years conducting clinical audits on itemized bills
• 3+ years of nursing experience in inpatient and outpatient settings
• Strong understanding of audit standards and healthcare regulations

Benefits

• Work from anywhere in the US, promoting a digital-first environment
• Comprehensive medical, dental, and vision insurance for employees and their families
• Flexible work environment prioritizing employee empowerment
• Unlimited paid time off for work-life balance
• 401(k) plan with employer match to support financial security

Our client is an equal opportunity employer. We encourage you to apply even if you don’t meet every qualification—your background could be exactly what this team needs.