PRN Clinical Review Nurse, RN

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🔥 0 minutes ago

🇺🇸 United States – Remote

⏱ Part Time

🟡 Mid-level

🟠 Senior

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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

• 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 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 for escalations or complex cases • Provide clinical review support on an as-needed basis to address inventory fluctuations and client demand • Manage review inventory while maintaining quality and compliance standards

🎯 Requirements

• Active, unrestricted RN license; compact license 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 appeal 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, including medical necessity, no-auth, and 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 • Ability to work independently with defined productivity expectations • Availability for weekdays and/or short-term surge support • Ability to complete computer-based work for 6–8 hours a day and manage interruptions • Ability to occasionally lift and move materials weighing up to 20 lbs.

🏖️ Benefits

• Professional development and personal growth opportunities • Remote work • PRN / variable hours based on inventory needs