Authorization Management Clinical Reviewer

WellSky

Authorization Management Clinical Reviewer reviewing authorizations and ensuring medical necessity per InterQual guidelines. Collaborating with healthcare providers to improve health outcomes and manage care efficiently.

Posted 7/10/2026full-timeRemote • Kansas • 🇺🇸 United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical necessity review using InterQual guidelines, with a strong background in utilization management and compliance with healthcare standards. Proficient in collaborating with healthcare professionals to ensure optimal patient care and resource utilization.

Highest-signal resume keywords

Active RN LicenseUtilization Management ExperienceClinical Acute Nursing ExperienceKnowledge of ICD / CPT / DRGExperience with Managed Care

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Necessity ReviewUtilization ManagementInterQual GuidelinesClinical NursingDenials and Appeals

Soft Skills

CollaborationCommunicationProfessional Growth

Tools & Technologies

Window-Based Computer Programs

Certifications & Qualifications

Bachelor's Degree

Industry Keywords

Healthcare ComplianceFederal StandardsState StandardsAccreditation StandardsCMS Standards

About the role

Key responsibilities & impact

Review acute and post-acute authorizations for medical necessity using InterQual guidelines
Collaborate with case managers, physicians, and medical directors to ensure appropriate levels of care
Participate in team meetings, educational activities, and interrater reliability testing to maintain review consistency and professional growth
Ensure compliance with federal, state, and accreditation standards, and identify opportunities to enhance communication or processes
Utilize knowledge of resources available in the healthcare system to assist physicians and patients effectively
Perform other job duties as assigned

Requirements

What you’ll need

Bachelor's Degree or equivalent work experience
Active RN License
At least 4-6 years relevant work experience
2 years clinical acute nursing experience
1-2 years' of hospital-based utilization management experience
Denials and Appeals experience (Preferred)
Experience with managed care and CMS standards (Preferred)
UM/CM Knowledge of ICD / CPT / DRG’s (Preferred)
Proficient in the use of window-based computer programs (Preferred)

Benefits

Comp & perks

Excellent medical with Rx, dental, and vision benefits
Mental Health support through EAP
Generous paid time off, plus 13 paid holidays
100% vested 401(K) retirement plans
Educational assistance up to $2500 per year