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Remote Clinical Appeals Specialist

Location : Remote (NY State)
Job Type : Contract
Reference Code : 15128
Hours : Full Time
Required Years of Experience : 5
Required Education : A nursing degree from an accredited school
Travel : No
Relocation : No
Job Industry : Healthcare - Health Services
Job Category : Healthcare - Social Services/Mental Health

Job Description :

We have an immediate opening for a Remote Clinical Appeals Specialist to join our team in NY State! **PLEASE NOTE: Candidates MUST have 5+ years current or recent appeals, case or utilization management experience, and an active, unrestricted NY State RN license to qualify - no exceptions!

Hours: full-time; 40 hrs/wk (with possibility of 8-10 hrs/wk overtime)


Shift: Monday-Friday 8:30AM-5PM

Salary: up to $33/hr (based on experience)

Essential Responsibilities:
Reviewing UM and pharmacy cases for medical necessity, working closely with MDs at plan, writing letters in accordance with NYS regulations, communicating with members and providers, preparing cases for Fair Hearing.


Required Qualifications :

Required Experience:



  • 5+ years current or recent appeals, case or utilization management experience


Required Education:



  • A nursing degree from an accredited nursing program


Required License(s):



  • Active, unrestricted NY State RN license in good standing


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