PRN Clinical Review Specialist

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a PRN Clinical Review Specialist based in the United States.

This role provides on-demand clinical review support within a fast-paced healthcare reimbursement environment, helping ensure accuracy, compliance, and timeliness in medical necessity determinations and appeal processes.
You will review complex medical records across inpatient and outpatient settings to assess appropriateness of care, authorization compliance, and payer policy alignment.
The position plays a critical role in supporting appeals workflows by developing clear, defensible clinical rationales that meet regulatory and payer requirements.
You will work independently in a remote setting, managing variable workloads based on client demand and inventory needs.
A key focus of the role is ensuring high-quality clinical documentation and adherence to strict turnaround times in a performance-driven environment.
You will collaborate with clinical leadership on complex cases while maintaining consistency across multiple payer guidelines and criteria sets.
This is a flexible PRN opportunity suited for experienced clinical professionals who thrive in autonomous, detail-oriented work.