Clinical Review Specialist

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔍🏥 Medical Reviewer

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CorroHealth

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare • Healthcare Insurance • SaaS

CorroHealth is a leading provider of clinically led healthcare analytics and technology-driven solutions, focused on enhancing the financial performance of hospitals and health systems. Their integrated solutions and advanced technologies aim to optimize the entire revenue cycle, offering services such as revenue cycle management, clinical documentation, medical coding, and denials management. With a commitment to improving financial health through intelligent technology and expert guidance, CorroHealth addresses complex payer-provider relationships and supports efficient healthcare operations.

📋 Description

• Prepare and submit appeals related to DRG downgrades and clinical validation denials • Perform clinical reviews for medical necessity, level of care, and authorization-related denials • Review inpatient and outpatient medical records to support appeal submissions • Apply payer-specific guidelines, including CMS, Medicaid, and commercial guidelines, along with internal policies • Identify documentation gaps and support clear, defensible clinical narratives • Meet assigned turnaround times while maintaining quality standards • Accurately document review findings in designated systems • Collaborate with clinical leadership on escalations and complex cases • Manage assigned inventory and adapt to changing priorities

🎯 Requirements

• Permanent work status required • Active, unrestricted RN license required (compact preferred) • Minimum 4–5 years of clinical experience • 4+ years of DRG, Utilization Review, Appeals, or Clinical Review experience • Strong knowledge of medical necessity criteria and payer guidelines • Experience reviewing inpatient and/or outpatient hospital claims • Proficiency with EMRs and review platforms (Epic preferred) • Strong written clinical documentation and time management skills • Ability to work Monday–Friday, 8:00 AM–5:00 PM • Ability to work independently remotely with defined productivity expectations • Ability to work at a computer terminal for 6–8 hours per day • Ability to sit for prolonged periods • Infrequent ability to lift and move materials weighing up to 20 lbs

🏖️ Benefits

• Full-time employment • Remote work within the United States • Professional development and personal growth opportunities • Long-term career development through employer investment • Reasonable accommodations for individuals with disabilities