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Remote Appeals Specialist - RN, LPN
A company is looking for an Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist, 100% Remote. Key Responsibilities Manage clinical case development and resolution, ensuring compliance with regulations Prepare cases for Medical Director Review and external appeal processes Handle all Department of Health and executive complaints as needed Required Qualifications Valid RN, LPN, or Dental Hygienist license Bachelor's degree preferred Experience in clinical practice and appeals & grievances or utilization management Understanding of Utilization Review Guidelines and related regulations Ability to manage large caseloads in a fast-paced environment
A company is looking for an Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist, 100% Remote.
Key Responsibilities
Manage clinical case development and resolution, ensuring compliance with regulations
Prepare cases for Medical Director Review and external appeal processes
Handle all Department of Health and executive complaints as needed
Required Qualifications
Valid RN, LPN, or Dental Hygienist license
Bachelor's degree preferred
Experience in clinical practice and appeals & grievances or utilization management
Understanding of Utilization Review Guidelines and related regulations
Ability to manage large caseloads in a fast-paced environment