Nurse specialist Jobs in Houston, TX

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

We are seeking a talented individual for a DRG Nurse Quality Auditor, Sr. Specialist who is responsible for performing on-going quality assurance audits of the accuracy and consistency of work performed by clinical and coding staff. Responsibilities include 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 and an active coding certification with a background in auditing medical records with a high level of understanding payment methodologies including MS-DRG, and APR-DRG.

What you will do

• Conducts QA audits to ensure accurate determinations and high-quality documentation.
• Identifies quality trends and develops corrective education and training.
• Reviews medical records for accurate coding, compliance, and guideline adherence.
• Applies job aids, policies, and criteria consistently during reviews.
• Documents review decisions clearly for reporting and trending.
• Meets productivity and quality standards while completing all review elements accurately.
• Supports and trains new reviewers, coders, or clinical DRG auditors as needed.
• Demonstrates strong knowledge of payment methodologies, DRG validation, and client-specific requirements.
• Maintains current knowledge of coding guidelines, licensure, and CEU requirements.
• Participates in trainings, cross-trains on claim types, and supports projects, analysis, and reporting.
• Serves as a subject matter expert as needed.

What we're looking for

What you should expect in this role

Applications for this posting will be accepted until March 22, 2026.

The pay range for this position is $85,000.00 - $99,000.00 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.