[Hiring] PRN Clinical Review Specialist @CorroHealth

Role Description

The PRN Clinical Review Specialist provides clinical review support on an as needed basis to assist with an increase in inventory and client demand. This role is responsible for reviewing medical records for medical necessity, level of care, authorization compliance, and payer guideline alignment across inpatient and outpatient services. The position supports timely appeal submissions and inventory management while maintaining quality and compliance standards.

Essential Duties and Responsibilities

• Perform clinical reviews for medical necessity, level of care, and authorization-related denial.
• 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.

Qualifications

• 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.

Preferred Qualifications

• Experience with payer appeals (medical necessity, no-auth, 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.

Work Expectations

• Remote, independent work with defined productivity expectations.

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.

Physical Demands

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. 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. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Members must be able to lift and move material weighing up to 20 lbs. Team Members may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.