Remote Nursing: Clinical Account Specialist (Utilization)

Neolytix

United States

Remote

USD 65,000 - 95,000

Full time

14 days+

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Job summary

Neolytix is seeking a remote, full-time Clinical Operations reviewer in the United States. The role leverages a nursing background to assess documentation for authorization, utilization review, and payer workflows.

You will manage high-volume queues across EHR/EMR, payer portals, and case management tools while maintaining productivity and audit-ready records. Candidates must have a nursing degree and healthcare BPO experience; HIPAA and quality standards compliance are essential.

Qualifications

A completed nursing degree combined with healthcare BPO experience.
Experience in reviewing clinical documentation for accuracy and medical necessity.
Familiar with working in high-volume, queue-driven environments and meeting SLAs.

Responsibilities

Review clinical documentation and chart notes for completeness and medical necessity.
Apply clinical judgment to prior authorization and utilization review requests.
Navigate EHR/EMR and payer portals while meeting daily productivity targets.
Document findings and communications audit-ready.
Coordinate with clinicians on cases requiring peer-to-peer reviews.
Escalate urgent cases and track to resolution.
Maintain HIPAA compliance and internal quality standards.