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Remote​/On-Site Clinical Appeals Specialist

Remote / Online - Candidates ideally in
Johnson City, Washington County, Tennessee, 37603, USA
Listing for: Healthfirst
Remote/Work from Home position
Listed on 2026-07-29
Job specializations:
  • Healthcare
    Healthcare Administration, Healthcare Management
Salary/Wage Range or Industry Benchmark: 73400 - 108160 USD Yearly USD 73400.00 108160.00 YEAR
Job Description & How to Apply Below

Healthfirst seeks an Appeals & Grievances Clinical Specialist to manage a caseload of member and provider cases related to authorization and service delivery. The role blends clinical case development with regulatory compliance and handles internal and external appeals.

The position can be remote or on-site at the NY or Lake Mary, FL locations, with some travel. Ideal candidates are RNs with experience in appeals, claims processing, and utilization management, and familiarity with UR guidelines.

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