Job Overview
Location
US - Remote
Job Type
Full-time
Category
Data Science
Date Posted
June 14, 2026
Full Job Description
đź“‹ Description
- • Perform clinical reviews to assess medical necessity, level of care, and authorization compliance for inpatient and outpatient services across all payer types.
- • Review comprehensive medical records to support appeal submissions for denials, recoupments, audits, and no-auth cases.
- • Apply payer-specific guidelines including CMS, Medicaid, and commercial insurer policies alongside internal clinical protocols.
- • Identify gaps in clinical documentation and develop clear, defensible, and persuasive clinical narratives to support appeal outcomes.
- • Accurately document all review findings and decisions in designated electronic systems, ensuring full compliance with regulatory and quality standards.
- • Meet strict turnaround time expectations while maintaining high accuracy and consistency in clinical decision-making.
- • Collaborate with clinical leadership to escalate complex cases requiring multidisciplinary input or policy interpretation.
- • Manage assigned inventory of cases efficiently, adapting to fluctuating workloads and shifting client priorities.
- • Utilize electronic medical records (EMRs) and clinical review platforms to access, analyze, and extract relevant clinical data for review.
- • Ensure all clinical determinations align with established medical necessity criteria and payer-specific utilization management standards.
- • Maintain strict adherence to confidentiality, HIPAA compliance, and internal audit requirements in all documentation and communications.
- • Work independently in a remote environment with defined productivity metrics and minimal supervision.
- • Function effectively in a high-volume, deadline-driven environment with frequent interruptions and sustained computer use (6–8 hours daily).
- • Perform all duties with attention to detail, clinical accuracy, and regulatory integrity to support client financial health goals.
🎯 Requirements
- • Active, unrestricted RN license (compact preferred)
- • Minimum 4–5 years of clinical nursing experience
- • 4+ years of experience in Utilization Review, Appeals, or Clinical Review
- • Strong knowledge of medical necessity criteria and payer guidelines (CMS, Medicaid, commercial)
- • Experience reviewing inpatient and/or outpatient hospital claims
- • Proficiency with EMRs and clinical review platforms (Epic preferred)
🏖️ Benefits
- • Remote work within the United States only
- • Structured Monday–Friday schedule (8:00 AM – 5:00 PM)
- • Opportunity for long-term career development and professional growth
- • Supportive environment focused on work-life balance and personal growth
Skills & Technologies
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About CorroHealth, Inc.
CorroHealth provides technology-enabled revenue cycle management and clinical documentation improvement services to hospitals and health systems. The company combines analytics, robotic process automation, and specialized coding expertise to reduce denials, improve compliance, and accelerate cash collections for providers nationwide.
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