Clinical Review Auditor - REMOTE

Lensa; Sarasota (FL); Remote; USD 60,000 - 85,000; Full time

Job summary

A leading healthcare provider is seeking a Clinical Review Analyst to manage the denial and appeal process. This remote position requires a licensed nurse with clinical experience to ensure timely submissions and improve patient care reimbursement. The role offers a chance to contribute to quality healthcare while enjoying flexible scheduling and comprehensive benefits.

Benefits

Health insurance

Flexible scheduling

401k

Student loan repayment programs

Qualifications

• Current RN/LPN licensure in Florida required.
• Clinical experience in an acute care setting preferred.
• Four to six years of relevant experience in healthcare financial services or appeals.

Responsibilities

• Manage denial/appeal process through analytic reviews.
• Draft and submit credible appeals in accordance with payer guidelines.
• Collaborate with team members to improve processes.

Skills

Attention to detail

Research skills

Multitasking

Education

High School Diploma

Nursing Degree

Master’s Degree

Tools

Word

Excel

Email software

Job description

2 days ago Be among the first 25 applicants

Lensa is the leading career site for job seekers at every stage of their career. Our client, Community Health Systems, is seeking professionals. Apply via Lensa today!

(Full-Time, Remote)

Position: Clinical Review Analyst

The Clinical Review Analyst is a licensed nurse/LPN responsible for managing the denial/appeal process through comprehensive analytic reviews of clinical and claim documentation. The CRA will triage cases, determine payment viability, and draft and submit credible, defensible appeals in accordance with payer guidelines to secure appropriate reimbursement for patient care.

As a Clinical Review Analyst at Community Health Systems, you will support our mission to help people get well and live healthier by providing safe, quality healthcare, building enduring patient relationships, and delivering value to communities. Our team benefits include health insurance, flexible scheduling, 401k, and student loan repayment programs.

Required Qualifications

• Clinical experience in an acute care setting
• High School Diploma and Nursing Degree
• Current RN/LPN licensure in Florida
• Proficiency with Word, Excel, and Email software
• Attention to detail, knowledge of healthcare pathophysiology, ability to multitask, and research skills using online tools

Preferred Qualifications

• Four to six years of relevant experience; healthcare financial services or appeals/denials experience
• Master’s Degree
• RN Licensure

Key Responsibilities

• Master utilization review criteria (e.g., Interqual), coverage guidelines, and payor policies
• Review and triage denials for appeals, billing, or adjustments
• Prioritize caseloads to ensure timely submissions
• Draft credible appeals supported by evidence-based research
• File appropriate levels of appeal (reconsideration, dispute, ALJ)
• Accurately enter data into relevant tracking and claim systems
• Identify and report patterns or trends to leadership
• Collaborate with team members to improve processes
• Maintain patient confidentiality per HIPAA guidelines

This is a remote position.

Community Health Systems is a leading healthcare provider operating in 40 markets across 15 states, with 70 hospitals and over 1,000 care sites, committed to quality and accessible healthcare.

To apply, email [e-mail]

Equal Employment Opportunity

Community Health Systems does not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or military service. Reasonable accommodations are available for applicants with disabilities. For assistance, contact Human Resources at the facility or visit http://www.chs.net/serving-communities/locations/.