New York Licensed Clinical Specialist

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 processes Handle member and provider complaints, maintaining documentation and communication Required Qualifications RN, LPN, or Dental Hygienist certification Bachelor's degree preferred Experience in clinical practice, appeals & grievances, or utilization management Understanding of Utilization Review Guidelines and related regulations Ability to manage large caseloads and work in a fast-paced environment

Created: 2026-03-05