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