Clinical Review Specialist, Active Unrestricted RN License Required
CorroHealth
part-time
Posted on:
Location Type: Remote
Location: United States
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About the role
- Provides clinical review support on an as-needed basis
- Responsible for reviewing medical records for medical necessity, level of care, authorization compliance, and payer guideline alignment
- Supports timely appeal submissions and inventory management while maintaining quality and compliance standards
- Performs clinical reviews for medical necessity, level of care, and authorization-related denials
- Reviews inpatient and outpatient medical records to support appeal submissions
- Applies payer-specific guidelines and internal policies
- Identifies documentation gaps and supports clear, defensible clinical narratives
- Meets assigned turnaround times while maintaining quality standards
- Documents review findings accurately in designated systems
- Collaborates with clinical leadership as needed for escalations or complex cases
Requirements
- Active, unrestricted RN license (compact preferred)
- Minimum 3–5 years of clinical experience
- 2+ years of Utilization Review, Appeals, or Clinical Review experience
- Strong knowledge of medical necessity criteria and payer guidelines
- Experience writing appeals letters
- Experience reviewing inpatient and/or outpatient hospital claims
- Proficiency with EMRs and review platforms (Epic preferred)
- Strong written clinical documentation and time management skills
- Experience with payer appeals (medical necessity, no-auth, readmissions)
- Familiarity with InterQual, MCG, or payer-specific criteria
- Prior remote clinical review experience
- Multi-client or vendor-side experience
- Knowledge of Medicare, Medicaid, and commercial payer processes
Benefits
- Remote, independent work
- Defined productivity expectations
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical reviewmedical necessity criteriaauthorization complianceappeals writinginpatient claims reviewoutpatient claims reviewpayers guidelinesInterQualMCGEMR proficiency
Soft Skills
time managementwritten communicationcollaborationquality standards adherencedocumentation accuracy
Certifications
RN license