Clinical Appeals Specialist
6 days ago
Job Summary
The Clinical Appeals Nurse is a critical role within Actalent, responsible for managing clinical appeals and state hearings across all states. This position involves reviewing and completing both provider and member clinical appeals within designated timeframes, preparing State Hearing packets, and ensuring communication with state agencies and internal departments.
Key Responsibilities
- Review and complete clinical appeals in a timely manner, ensuring compliance with regulatory standards.
- Prepare State Hearing packets and ensure accurate documentation.
- Communicate effectively with state agencies and internal departments to resolve appeals.
- Collaborate with the Quality Improvement and Clinical Operations Team to manage requests for Independent External Review.
- Attend State Hearings and issue notification letters as required.
Work Environment
This is a fully remote role, requiring the ability to work independently and manage time effectively. Consultants will need to provide their own equipment, including a computer, internet, and phone.
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation, and speed to market.
Diversity, Equity & Inclusion
At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
- Hiring diverse talent.
- Maintaining an inclusive environment through persistent self-reflection.
- Building a culture of care, engagement, and recognition with clear outcomes.
- Ensuring growth opportunities for our people.
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