Clinical Review Clinician - Appeals

Spectraforce Technologies

United States, Ohio, Columbus

Oct 13, 2025

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.