PRN Clinical Review Specialist
Remote · United States
Job Summary
PRN Clinical Review Specialist provides remote clinical review support to assess medical necessity, level of care, and authorization compliance across inpatient and outpatient services. The role involves reviewing medical records to support timely, clear, and defensible clinical narratives for appeals and denials, applying payer-specific guidelines (CMS, Medicaid, commercial) and internal policies, identifying documentation gaps, and meeting turnaround time and quality standards. Requires active RN license (compact preferred), 4–5 years of appeals or utilization review experience, strong knowledge of medical necessity criteria, proficiency with EMR systems (Epic preferred), and excellent written documentation and time-management skills. Remote, independent work with defined productivity expectations; experience with payer appeals, InterQual/MCG familiarity, and multi-client/vendor environments is preferred. CorroHealth is the parent brand.
Required Qualifications
- RN license (active, unrestricted)
- 4–5 years of appeals or utilization review experience
- experience reviewing inpatient and/or outpatient hospital claims
- proficiency with EMRs (Epic preferred)
- strong written clinical documentation and time management skills
- familiarity with payer guidelines (CMS, Medicaid, commercial)
- ability to perform medical necessity and level of care reviews
- remote work capability
- multi-client or vendor-side experience (preferred)
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