🚨 HIRING: CLINICAL REVIEW AND MEDICAL DOCUMENTATION SPECIALIST 📍 Remote - Independent Contractor | PHILIPPINES 🇵🇭 Agents Only Technologies Inc. is seeking experienced healthcare professionals in the Philippines for a specialized project covering 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 expertise. 🔹 TIER 1 – PRIOR AUTHORIZATION AND UTILIZATION REVIEW • Develop/evaluate prior-authorization scenarios • Make Approve / Deny / Request More Information recommendations • Apply CMS NCD/LCD and medical-necessity standards • Work across clinical specialties Required: • Active RN license or MD/DO • 3+ years in UM, prior authorization, case management, clinical review, or payer-side review • Strong clinical reasoning and documentation skills • US healthcare/payer experience preferred Preferred: • Peer-to-peer review • CPUR / ACM or equivalent UM certification • Healthcare content/evaluation experience 🔹 TIER 2 – PRIOR AUTHORIZATION AND APPEALS • Review charts/evidence for medical necessity • Develop evidence packets • Draft physician-level appeal documentation • Research/cite PubMed and peer-reviewed literature Required: • RN, MD/DO, or relevant clinical documentation qualification • 3+ years in prior authorization, UM, clinical documentation, or denials/appeals • Clinical documentation review experience • Strong evidence-based medical writing • US healthcare/payer/appeals experience preferred Preferred: • Payer appeals • Denials and appeals • Evidence research 🔹 TIER 3 – MEDICAL RECORD SYNTHESIS • Review complex multi-encounter 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 background • 3+ years relevant experience • Medical record review experience • Strong medical summarization and structured writing • US healthcare documentation experience is an advantage Preferred: • RHIA / RHIT • CDIP / CCDS • HEDIS / MIPS • Healthcare data/content experience 🎓 RELEVANT BACKGROUNDS Nursing | Medicine | HIM | CDI | Clinical Informatics | Utilization Management | Medical Review | Healthcare Administration 💼 JOB DETAILS Remote | Independent Contractor | Philippines Paid Hourly | Project-dependent / Flexible

Clinical Review and Medical Documentation Specialist

Emma

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Agents only Technologies

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