Remote Clinical Quality Reviewer - Prior Authorization

CorroHealth Inc; Town of Texas (WI); On-site; USD 85,000 - 110,000; Full time

Job summary

CorroHealth Inc. in the United States seeks a Clinical Reviewer to support the WISeR Prior Authorization Program. You will perform comprehensive clinical reviews, assess medical necessity, and validate documentation in line with CMS and WISeR guidelines.

This remote, 24/7 capable role requires strong analytical and communication skills and collaboration with physicians, nurses, and cross-functional teams. RN licensure is required; CPT and ICD-10 coding proficiency is essential.

Qualifications

• RN licensure required and in good standing.
• Experience reviewing clinical documentation for medical necessity.
• Strong written and verbal communication skills.

Responsibilities

• Perform clinical reviews of prior authorization requests per CMS/WISeR guidelines.
• Evaluate documentation to determine medical necessity and service appropriateness.
• Validate AI-assisted outcomes and escalate gaps.
• Support P2P review processes and expedited requests.

Skills

Clinical judgment

Analytical skills

Written communication

Verbal communication

Healthcare software proficiency

Education

RN license

Tools

CPT coding

ICD-10 coding

EHR systems

Job description

CorroHealth Inc. in the United States seeks a Clinical Reviewer to support the WISeR Prior Authorization Program. You will perform comprehensive clinical reviews, assess medical necessity, and validate documentation in line with CMS and WISeR guidelines.

This remote, 24/7 capable role requires strong analytical and communication skills and collaboration with physicians, nurses, and cross-functional teams. RN licensure is required; CPT and ICD-10 coding proficiency is essential.