Position Title: Clinical Review Clinician – Appeals
Work Location: Remote – Ohio (Columbus area preferred)
Assignment Duration: 6 months
Work Schedule: 8a–5p (NO OT required)
Work Arrangement: Remote

Position Summary:
• Perform appeal review for medical necessity, complete appeal cases (making determination, documenting outcome, sending out letter, and closing out appeal in system).
• Behavior and accountability and ability to pivot when new priorities come up.
• Emails and Team chats to ensure communication is reached and assistance is available, if needed.

Candidate Requirements:
Education/Certification
• Required: LPN Minimum
• Preferred: RN – Not required

Licensure
• Required: LPN minimum

Nice to Haves:
• Direct patient care experience
• Longevity at positions
• Writing appeal or authorization outcome letters
• Experience with Trucare and/or Amisys systems is greatly valued
• Utilization review nurse, appeal review nurse and direct patient care experience

Disqualifiers:
• Not possessing the must haves

Performance Indicators (Metrics):
• 10 to 15 appeals a day after training
• Not letting any items in work queues go over compliance Turn Around Time

 

Candidate Requirements
Education/Certification	Required: LPN Minimum			Preferred: RN-Not required
Licensure	Required: LPN minimum			Preferred:
Years of experience required Disqualifiers Best vs. average Performance indicators		Must haves: (SEE NUMBERED SECTION BELOW)   Nice to haves: Direct patient care experience Longevity at positions Writing appeal or authorization outcome letters. experience with Trucare and/or Amisys systems is greatly valued. •                Utilization review nurse, appeal review nurse and direct patient care experience.   Disqualifiers: Not possessing the must haves   Performance indicators: (Metrics: •10 to 15 appeals a day after training. Not letting any items in work queues go over compliance Turn Around Time.)   Best vs. average:
Top 3 must-have hard skills Level of experience with each Stack-ranked by importance Candidate Review & Selection		1	Experience with Utilization Review/Management--2 yrs
		2	Reviews relevant information within denied authorization/prior authorization case to ensure a complete case summary is provided to the Medical Director for review of the appeal case.
		3	Review medical code data and records to determine whether a denial is warranted.
		4	Utilizing multiple appeals/claims systems to conduct medical reviews.
		5	Comfortable with Microsoft office programs and utilizing systems to input medical criteria.

 
 
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $ 33.33/hr.