Clinical Appeals Reviewer (Licensed Healthcare Professional)

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Clinical Appeals Reviewer (Licensed Healthcare Professional) based in the United States.

This is a fully remote clinical decision-making role focused on conducting independent, evidence-based reviews of medical appeals for federal healthcare programs. You will evaluate complex case files, assess medical necessity, and ensure determinations align with applicable regulations, policies, and clinical guidelines. The role requires strong clinical judgment, attention to detail, and the ability to translate medical evidence into clear, defensible written decisions. You will serve as an impartial reviewer, helping ensure fairness, accuracy, and compliance in healthcare determinations that directly impact beneficiaries and providers. The environment is structured, mission-driven, and highly detail-oriented, with opportunities to contribute to quality improvement and mentor others. This position is best suited for experienced licensed clinicians who are confident in independent decision-making and regulatory interpretation.

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Clinical Appeals Reviewer (Licensed Healthcare Professional) based in the United States.

This is a fully remote clinical decision-making role focused on conducting independent, evidence-based reviews of medical appeals for federal healthcare programs. You will evaluate complex case files, assess medical necessity, and ensure determinations align with applicable regulations, policies, and clinical guidelines. The role requires strong clinical judgment, attention to detail, and the ability to translate medical evidence into clear, defensible written decisions. You will serve as an impartial reviewer, helping ensure fairness, accuracy, and compliance in healthcare determinations that directly impact beneficiaries and providers. The environment is structured, mission-driven, and highly detail-oriented, with opportunities to contribute to quality improvement and mentor others. This position is best suited for experienced licensed clinicians who are confident in independent decision-making and regulatory interpretation.

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

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