PRN Clinical Review Specialist

Clinical Review and Appeals:

• Perform clinical reviews for medical necessity, level of care, and authorization-related denials.
• Review inpatient and outpatient medical records to support appeal submissions.
• Identify documentation gaps and support clear, defensible clinical narratives.

Qualifications and Experience:

• Active, unrestricted RN license (compact preferred) with 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.

Work Environment and Expectations:

• Remote, independent work with defined productivity and quality standards.
• Ability to adapt to changing inventory and priorities in a fast-paced setting.
• Collaboration with clinical leadership for escalations or complex cases.