Clinical Review Clinician - Appeals
Remote-NYremote$56K – $101K
Posted today · via Workday
About this role
Position Purpose: Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards. Key Details: This fully remote, Monday–Friday position strongly prefers an active, unrestricted New York State RN license; a BSN and CCM or other utilization management certification are also preferred. Candidates should have 2+ years of acute care experience, utilization management or appeals experience, and working knowledge of MCG/InterQual criteria and NYS Medicaid, Medicare, and Marketplace appeal regulations.…
What we'd score you on
reqspace match rubricFive dimensions, recruiter-grade. Upload your resume and we'll generate a written explanation of where you fit and where the gaps are.
1
Skills match
For this role: monday, teams
2
Level fit
We check your title trajectory against the seniority signal of the role.
3
Domain experience
Your work in the role's domain matters more than your years total. We weight recent and direct experience.
4
Recency
A skill you used last quarter weighs more than one from five years ago. We grade on recency, not lifetime.
5
Location fit
This role is remote-eligible. We factor in your stated location and time-zone overlap.
Score yourself on this role.
Free · no card · written explanation included
Skills in this role
Pulled from the job description. These are the keywords we'll weight when scoring your fit.
mondayteams