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Key Responsibilities:
- 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.
Required Qualifications:
- Active, unrestricted RN license (compact preferred).
- Minimum 4–5 years of clinical experience and 4+ years of Utilization Review, Appeals, or Clinical Review experience.
- Strong knowledge of medical necessity criteria, payer guidelines, and proficiency with EMRs (Epic preferred).
Work Expectations:
- Remote, independent work with defined productivity expectations.
- Timely completion of assigned reviews with accurate application of clinical criteria.
- Ability to adapt to changing inventory and priorities.
CorroHealth
CorroHealth helps clients exceed their financial health goals by providing scalable solutions and clinical expertise across the reimbursement cycle. The company fosters a supportive culture that invests in professional development and personal growth.