Clinical Review Specialist

Job not on LinkedIn

🕒 6 days ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔍🏥 Medical Reviewer

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CorroHealth

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

⚕️ Healthcare Insurance

☁️ SaaS

🤖 Artificial Intelligence

Healthcare Insurance • SaaS • Artificial Intelligence

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

• Provides clinical review support on a full-time basis to assist with an increase in inventory and client demand. • Responsible for reviewing medical records for medical necessity, level of care, authorization compliance, and payer guideline alignment across inpatient and outpatient services. • Supports timely appeal submissions and inventory management while maintaining quality and compliance standards. • 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 (CMS, Medicaid, commercial) and internal policies. • Identify documentation gaps and support clear, defensible clinical narratives. • Meet assigned turnaround times while maintaining quality standards. • Document review findings accurately in designated systems. • Collaborate with clinical leadership as needed for escalations or complex cases.

🎯 Requirements

• Active, unrestricted RN license (compact preferred) • Minimum 4–5 years of clinical experience • 4+ years of 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. • 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

• Professional development • Remote, independent work with defined productivity expectations