Title: Clinical Review Clinician - Appeals Duration: 06 Months (Potential to extend) Location: Remote (OH, preferrable columbus area) Walk me through the day to day responsibilities of this the role and a description of the project (Outside of Workday JD): 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 Describe the performance expectations/metrics for this individual and their team: 10 to 15 appeals a day after training. Not letting any items in work queues go over compliance Turn Around Time. Required Skills/Experience: Preferred Skills/ Experience: 1. Experience with Utilization Review/Management--2 yrs 1. Direct patient care experience 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. 2. Longevity at positions 3. Review medical code data and records to determine whether a denial is warranted. Utilizing multiple appeals/claims systems to conduct medical reviews. 3. Writing appeal or authorization outcome letters. 4. 4. experience with Trucare and/or Amisys systems is greatly valued. Education Requirement: LPN Minimum Education Preferred: RN-Not required Software Skills Required: Comfortable with Microsoft office programs and utilizing systems to input medical criteria. SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at if you require reasonable accommodation.