Appeals Clinician (Monday - Friday)
PacificSource Health Plans(1 month ago)
About this role
The Appeals Clinician represents the clinical component of member and provider appeals for a health plan, ensuring regulatory compliance and fair determinations. The role synthesizes clinical evidence and case information into concise summaries presented to the Medical Director and collaborates with internal and external stakeholders to support appeals and quality assurance processes.
Required Skills
- Clinical Review
- Case Presentation
- Policy Application
- Research
- Regulatory Compliance
- Medical Coding
- Claims Analysis
- Communication
- Collaboration
- Lean Methodologies
+5 more
Qualifications
- Registered Nurse (RN)
- Licensed Behavioral Health Specialist
- Unrestricted State License
- Oregon License
- Montana License
- Idaho License
- Washington License
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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