MEDICAL NECESSITY CLINICAL REVIEW SPECIALIST FT

About Legent Health

At Legent Health, our mission is simple yet profound: “To provide first-class health care that puts YOU first.”

Our vision reflects our commitment to excellence: “Through robust physician partnerships, become a nationwide leader in compassionate, quality healthcare focused on the patient and available to everyone.”

Our values, also known as our brand pillars, define how we stay true to our identity in the healthcare industry and the communities we serve. These values are central to everything we do:

• Respect: We honor the time and trust of both patients and physicians by delivering organized, efficient services that ensure a seamless healthcare experience.
• Service: We are committed to highly personalized care for patients, their families, and the physicians who serve them, driving optimal outcomes for all.
• Leadership: We strive to be a trusted leader through innovation, clear communication, and unwavering dedication to excellence across our employees and partners.

Joining Legent Health means being part of a team that lives these principles every day, as we build a future focused on compassionate, quality care.

About the Role

The Medical Necessity Clinical Review Specialist supports Legent Health’s revenue integrity process by conducting pre-service case reviews to ensure that surgical and procedural cases meet payer-specific criteria for medical necessity prior to service. Utilizing Legent’s AI-Enabled Medical Necessity & Authorization Tool, this role assists with identifying documentation gaps against payer guidelines, preparing gap analyses for physician review and education, and establishing clinical criteria to support appeals when needed. The specialist collaborates with authorization teams, facility leadership, physicians, and revenue cycle staff to strengthen the organization’s pre-service review processes.

POSITION’S ESSENTIAL RESPONSIBILITIES:

EDUCATION AND EXPERIENCE REQUIREMENTS:

Why Join Legent Health?

Legent Health fosters an environment where team members are empowered to deliver exceptional care while growing professionally within a supportive, values-driven culture.

We Offer:

• Competitive salary and performance incentives
• Comprehensive benefits package
• Paid time off and wellness programs
• Career development and training opportunities

Equal Employment Opportunity (EEO) Statement

Legent Health is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, disability status, or any other legally protected characteristic.

I-9 and E-Verify Compliance:
Employment eligibility will be verified through the U.S. Department of Homeland Security’s E-Verify system. All applicants must provide valid documentation to establish identity and authorization to work in the United States, as required by federal law.