P32HS Point32Health Services IncHiring

Appeals Clinical Consultant

  • Remote, United States
  • Mid-level
  • Posted 4 days ago
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In one line

Clinical role inside an appeals and grievances department at a nonprofit health plan, supporting analysts and reviewers on complex member and provider appeals.

About the role

Appeals and grievances work in a managed care setting, mainly commercial plans and Medicaid, where clinical judgment shapes how cases are reviewed and decided.

At a glance

Pay
Not stated in the posting
Remote scope
Remote, United States
Seniority
Mid-level
Skills
Managed care, Medicaid, Appeals and grievances, Medical terminology
Posted
31 Oct 2026
Last checked
2 Nov 2026

What you will do

  • Act as the clinical resource for the appeals and grievances department
  • Help analysts understand medical terminology and providers' care plans when reviewing appeals
  • Consult with analysts and physician reviewers on complex cases and prepare them for committee votes

What they look for

  • Knowledge of appeals and grievances processes in managed care
  • Familiarity with commercial plans and Medicaid
  • Ability to work independently and as part of a team

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Questions about this job

Can I do this job remotely, and from which countries?

Yes. The posting lists Appeals Clinical Consultant as a remote role for candidates in the United States.

What does this job pay?

No pay range is stated in the posting.

What experience is needed?

It is a mid-level role. The posting asks for: knowledge of appeals and grievances processes in managed care; familiarity with commercial plans and Medicaid; ability to work independently and as part of a team. Skills it names include Managed care, Medicaid, Appeals and grievances, Medical terminology.

How do I apply with Keywordise AI?

Press the Apply with Keywordise AI button and add your CV. Keywordise tailors your CV and cover letter to this posting and sends the application for you, with a free 7-day trial and no card.

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