Remote Clinical Review Nurse - Utilization & Appeals

CorroHealth; United States; On-site; USD 60,000 - 120,000; Part time

Job summary

CorroHealth provides remote PRN clinical review support to assist with fluctuations in inventory and client demand. The role reviews medical records for medical necessity, level of care, authorization compliance, and payer guideline alignment across inpatient and outpatient services.

This is a remote position. The ideal candidate holds an active RN license with 3–5 years of clinical experience and at least 2 years in Utilization Review or Appeals, plus strong documentation and payer guidelines

Qualifications

• Active, unrestricted RN license (compact preferred).
• 3–5 years of clinical experience.
• 2+ years of Utilization Review, Appeals, or Clinical Review experience.
• Strong knowledge of medical necessity criteria and payer guidelines.
• Experience writing appeals letters.
• Experience reviewing inpatient and/or outpatient hospital claims.
• Proficiency with EMRs and review platforms (Epic preferred).
• Strong written clinical documentation and time management skill.
• 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.

Responsibilities

• Perform clinical reviews for medical necessity, level of care, and authorization-related denials.
• 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.

Skills

RN license

Clinical experience

Utilization Review

Appeals writing

Payer guidelines

Epic

Remote work

Time management

Healthcare compliance

Tools

Epic EMR

Job description

CorroHealth provides remote PRN clinical review support to assist with fluctuations in inventory and client demand. The role reviews medical records for medical necessity, level of care, authorization compliance, and payer guideline alignment across inpatient and outpatient services.

This is a remote position. The ideal candidate holds an active RN license with 3–5 years of clinical experience and at least 2 years in Utilization Review or Appeals, plus strong documentation and payer guidelines