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Clinical Review Clinician - Appeals

Spectraforce Technologies

United States, Florida, Jacksonville

13141 City Station Drive (Show on map)

Nov 18, 2025

Position Title: Clinical Review Clinician Appeals

Work Location: Remote national WITH COMPACT LICENSE - Must work CST hours listed in daily schedule

Assignment Duration: 3 months

Work Arrangement: Remote

Work Schedule: Training 8AM-5PM CST - NO TIME OFF - CAMERAS ON - 3 weeks. 8AM-5PM CST or 9AM-6PM CST (candidate can choose schedule but training will be 8AM-5PM CST) - no OT - no weekends.

Position Summary:

BH appeals management-clinical reviews, auth updates, correspondence.

Cross functional clinical team that supports multiple markets with high volumes and short turnaround times.

Background & Context:

Review incoming appeals based on market turnaround times (24 hrs +), send to MD for decision, process outcomes and send correspondence, knowledge of BH service types and current regulations for Medicaid /Marketplace.

Key Responsibilities:

Review incoming appeals based on market turnaround times (24 hrs +).
Send to MD for decision.
Process outcomes and send correspondence.
Knowledge of BH service types and current regulations for Medicaid /Marketplace.
Required - 6 closed appeals per day/ or 12 retros per day.
May need to reach out to providers/members verbally.
Applications: trucare, excel for case loads, outlook, teams, word doc.

Qualification & Experience:

Required: RN compact
2-4 yrs BH clinical experience/substance use/residential treatment. Appeals & UM experience a must.
Disqualifiers: LPN, LVN, social worker.
Additional qualities to look for: agile, flexibility, BH experience.

Preferred: (none listed)

Education/Certification	Required: RN compact	Preferred:
Licensure	Required: RN compact	Preferred:
Years of experience required: 2-4 yrs BH clinical experience/substance use/residential treatment. Appeals & UM experience a must. Disqualifiers: LPN, LVN, social worker, Additional qualities to look for: agile, flexibility, BH experience
Top 3 must-have hard skills stack-ranked by importance	1	BH clinical experience
2	Utilization review/appeals review exp.
3	Computer knowledge

Position is offered by a no fee agency.