**Description** PURPOSE: The Clinical Appeals Specialist completes research basic analysis and evaluation of member and provider disputes regarding adverse and adverse coverage decisions. The Clinical Appeals Specialist utilizes clinical skills and knowledge of all applicable State and Federal rules and regulations that govern the appeal process for Commercial and Government Programs lines of business in order to formulate a professional response to the appeal request. ESSENTIAL FUNCTIONS: + Investigates interprets and analyzes written appeals and reconsideration requests from multiple sources including applicants subscribers attorneys group administrators internal stake holders and any other initiators. Responds to such requests with original letters complex and technical in nature upholding corporate policies and decisions while meeting all State and Federal regulations and mandates. + Organizes the appeal case for physician review by compiling clinical contractual medical policy and claims information along with corporate and appellant correspondence. Formulates recommendations for disposition. Prepares the written case for review and following the physician review communicates the final decision to the member and providers including an explanation of the final decision and all External appeal rights. Licenses/Certifications RN - Registered Nurse - State Licensure And/or Compact State Licensure Upon Hire Req CCM - Certified Case Manager Upon Hire Pref LNCC - Legal Nurse Consultant Certified Upon Hire Pref **Pay and Benefits** The pay range for this position is $39.00 - $44.00/hr. **Workplace Type** This is a fully remote position. **About Aerotek:** We know that finding work is hard, and finding meaningful work is harder. Aerotek connects 180,000+ light industrial and skilled trades workers with 14,000+ employers each year, helping our workers navigate an evolving labor market and find jobs that meets their goals, skills and interests. Since 1983, we have provided a variety of career opportunities across North American industry – from short-term assignments at Fortune 500 companies where you can build your skills, to long-term opportunities where you can play a vital role solving for companies’ construction, manufacturing and maintenance challenges. Our 1,500+ experienced recruiters across 250+ offices work relentlessly to put our workforce in a position to thrive. Let us rise to meet your challenges and put our people-are everything spirit to the test as your career continues to grow. Aerotek offers weekly pay, employee benefits including medical, dental & vision, life insurance, health advocacy and employee assistance programs, a 401(k) plan, and employee discounts. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.