Appeals Clinician (Monday - Friday)
PacificSource Health Plans(1 month ago)
About this role
An Appeals Clinician at PacificSource represents the clinical component of member and provider appeals by providing accurate, evidence-based clinical summaries for final determination by the medical director. The role emphasizes regulatory compliance, collaboration with internal and external partners, and maintaining clinical knowledge to support member access to quality care.
Required Skills
- Clinical Review
- Case Presentation
- Policy Interpretation
- Medical Coding
- Collaboration
- Customer Service
- Lean Methodologies
- Data Analysis
- HIPAA Compliance
Qualifications
- Registered Nurse
- Licensed Behavioral Health Specialist
- Unrestricted State License
- State Licensure (OR, MT, ID, WA)
About PacificSource Health Plans
pacificsource.comPacificSource offers health insurance plans for individuals, families, and employers. A Northwest not-for-profit, we put members first.
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