PRN Clinical Review Specialist (Active RN License REQ'D)
CorroHealth · United States
- Hybrid
- Part-time
- $75,000 / year
- United States
Job highlights
- Review medical records for complex denials.
- Utilize clinical expertise for appeal support.
- Work remotely within the United States.
- Must hold an active RN license.
- PRN role with flexible scheduling.
About the role
About Us
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.
Job Summary
This is a REMOTE position within the US Only. Required: Active, unrestricted RN license (compact preferred) and 4–5 years of appeals experience, be skilled in reviewing ALL kinds of denials, recoupments, audits, no‑auth cases, and other complex determinations. Must be able to perform UM reviews and write clear, persuasive clinical appeals and have prior leadership experience. 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.
Key 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.
Required 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
Note: 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 Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
Key skills/competency
- RN License
- Clinical Review
- Appeals
- Medical Necessity
- Utilization Review
- EMR Proficiency
- Epic EMR
- Time Management
- Clinical Documentation
- Payer Guidelines
Skills & topics
- RN
- Clinical Review Specialist
- Appeals
- Utilization Review
- Medical Necessity
- Remote Work
- Healthcare
- Nursing
- EMR
- Epic
How to get hired
- Customize your resume: Highlight your active RN license, 4-5 years of appeals experience, and proficiency with EMRs like Epic.
- Tailor your cover letter: Emphasize your experience with various denial types and your ability to write clear clinical appeals for CorroHealth.
- Prepare for interviews: Be ready to discuss your experience with UM reviews, medical necessity criteria, and payer guidelines.
- Showcase remote work skills: Demonstrate your ability to work independently, manage time effectively, and meet productivity expectations in a remote setting.
- Highlight leadership potential: If applicable, mention any prior leadership experience as requested in the job description.
Technical preparation
Behavioral questions
Frequently asked questions
- What is the work arrangement for the PRN Clinical Review Specialist RN position at CorroHealth?
- The PRN Clinical Review Specialist RN position at CorroHealth is a remote role, allowing you to work from anywhere within the United States. As a PRN position, it is on an as-needed basis, offering flexibility in your schedule.
- What are the essential qualifications for the PRN Clinical Review Specialist RN job at CorroHealth?
- To be considered for the PRN Clinical Review Specialist RN role at CorroHealth, you must possess an active, unrestricted RN license (a compact license is preferred) and have 4-5 years of experience in clinical appeals. You should be skilled in reviewing various types of denials, recoupments, audits, and no-auth cases, and be capable of performing UM reviews and writing persuasive clinical appeals.
- What specific types of denials will a PRN Clinical Review Specialist RN at CorroHealth review?
- A PRN Clinical Review Specialist RN at CorroHealth will review all kinds of denials, including recoupments, audits, no-auth cases, and other complex determinations. This includes performing UM reviews and assessing medical necessity, level of care, and authorization compliance for both inpatient and outpatient services.
- Is prior leadership experience required for the PRN Clinical Review Specialist RN role at CorroHealth?
- While not strictly mandatory, prior leadership experience is listed as an ideal qualification for the PRN Clinical Review Specialist RN at CorroHealth. It is a strong asset that can differentiate your application, especially when combined with the required RN license and appeals experience.
- What are the technical skills needed for the PRN Clinical Review Specialist RN position at CorroHealth?
- Proficiency with Electronic Medical Records (EMRs) and review platforms is essential. Specifically, experience with Epic is preferred. You will also need strong written clinical documentation skills and effective time management abilities to succeed in this role at CorroHealth.
- How does CorroHealth support professional growth for its PRN Clinical Review Specialist RNs?
- CorroHealth is committed to building long-term careers and invests in the professional development and personal growth of its team members. They aim to create an environment that cultivates success, believing that employee growth directly contributes to the company's success.