🚨 HIRING: CLINICAL REVIEW AND MEDICAL DOCUMENTATION SPECIALIST 📍 Remote - Independent Contractor | UNITED STATES 🇺🇸 Agents Only Technologies Inc. is seeking experienced U.S.-based healthcare professionals for a specialized project in prior authorization, utilization management, appeals, clinical documentation, and medical record synthesis. Candidates may be considered for Tier 1, Tier 2, or Tier 3 based on their expertise. 🔹 TIER 1 – PRIOR AUTHORIZATION AND UTILIZATION REVIEW • Develop/evaluate prior-authorization scenarios • Approve / Deny / Request More Information decisions • Apply CMS NCD/LCD and medical-necessity standards Required: • Active U.S. RN license or MD/DO • 3+ years in UM, prior authorization, case management, clinical review, or payer-side review • Direct U.S. healthcare UM experience • Strong clinical reasoning and documentation skills Preferred: • Peer-to-peer review • CPUR / ACM or equivalent UM certification • Medicare, Medicaid, or commercial payer experience 🔹 TIER 2 – PRIOR AUTHORIZATION AND APPEALS • Review charts and medical-necessity evidence • Develop authorization evidence packets • Draft appeal documentation • Research PubMed and peer-reviewed literature Preferred: • Payer appeal-letter experience • Health plan / payer denials and appeals • Medicare, Medicaid, or commercial insurance experience Required: • U.S.-licensed RN, MD/DO, or relevant clinical documentation professional • 3+ years in prior authorization, UM, clinical documentation, denials, or appeals • U.S. healthcare/payer experience • Strong evidence-based medical writing 🔹 TIER 3 – MEDICAL RECORD SYNTHESIS • Review complex medical records • Create chronological clinical summaries • Identify duplicate/redundant testing • Maintain source traceability • Work with C-CDA XML and/or FHIR Required: • HIM, CDI, or related healthcare background • 3+ years relevant experience • Medical record review experience • Strong medical summarization and structured writing • U.S. healthcare documentation familiarity Preferred: • RHIA / RHIT • CDIP / CCDS • HEDIS / MIPS • Clinical data or content experience 🎓 BACKGROUNDS: Nursing | Medicine | HIM | CDI | Clinical Informatics | Utilization Management | Medical Review | Healthcare Administration 💼 Remote | Independent Contractor | Paid Hourly | Flexible / Project-Dependent Only shortlisted candidates will be contacted.

Clinical Review and Medical Documentation Specialist

Emma

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Agents only Technologies

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www.agentsonly.com/

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