Clinical Review Nurse

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.

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.

Analyze denied insurance claims and complete medical records. 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.