CorroHealth
RN, Clinical Review Specialist/Medical Necessity Appeals (FT/REMOTE)
US - Remote
Sponsorship not specifiedDetected 1 day ago
Inventory ManagementEpicLeadershipTime Management
About the role
- Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties.
- Specific tasks, responsibilities or competencies may be documented in the Team Member's performance objectives as outlined by the Team Member's immediate Leadership Team Member.
- This is a REMOTE position within US ONLY
Responsibilities
- Identify documentation gaps and support clear, defensible clinical narratives
- Document review findings accurately in designated systems
- Collaborate with clinical leadership as needed for escalations or complex cases
Requirements
- Minimum 4-5 years of clinical experience
- 4+ years of Utilization Review, Appeals, or Clinical Review experience
- Experience reviewing inpatient and/or outpatient hospital claims
- Required Schedule: Monday - Friday, 8:00 - 5:00 PM
- Regular eye-hand coordination and manual dexterity is required to operate office equipment.
- The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required.
- Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs.
Nice to have
- Familiarity with InterQual, MCG, or payer-specific criteria
- Multi-client or vendor-side experience
- Knowledge of Medicare, Medicaid, and commercial payer processes
- Performance Expectations
- Timely completion of assigned reviews
- Accurate application of clinical criteria and payer policy
- Clear, compliant documentation
- Ability to adapt to changing inventory and priorities
Skills
- It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities.
Benefits
- Perform clinical reviews for medical necessity, level of care, and authorization-related denials
- Review inpatient and outpatient medical records to support appeal submissions
- Strong knowledge of medical necessity criteria and payer guidelines
Company info
- Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.
- We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.
- Our purpose is to help clients exceed their financial health goals.
- Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs.
- Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.
- We build long-term careers by investing in YOU.
- We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.
- The company has reviewed this job description to ensure that the essential functions and basic duties have been included.
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This listing is sourced directly from CorroHealth's careers page and normalized into a canonical job model.