Clinical Appeals Specialist — Remote or On-site Impact

Medimpact; San Diego (CA); On-site; USD 110,000 - 140,000; Full time

Benefits offered by this job

Medical/Dental/Vision

401K with match

Paid time off

Tuition reimbursement

Job summary

MedImpact Healthcare Systems, Inc. seeks an experienced Appeal Clinical Specialist to conduct independent clinical reviews in the appeals process.

You will evaluate medical records, apply criteria, and determine benefit coverage while ensuring timeliness and regulatory compliance. Responsibilities include drug information support, literature documentation, and coordinating utilization reporting for client plans.

Qualifications

• Clinical decision-making abilities in complex cases.
• Strong understanding of regulatory compliance and standards.
• Experience reviewing medical records for authorization decisions.
• Excellent written and verbal communication skills.

Responsibilities

• Conduct independent clinical reviews in appeals process.
• Evaluate medical records and apply criteria for benefit coverage.
• Provide drug information and literature to support decisions.
• Coordinate utilization and compliance reporting for client plans.
• Support appeal program development and cross-department projects.

Job description

MedImpact Healthcare Systems, Inc. seeks an experienced Appeal Clinical Specialist to conduct independent clinical reviews in the appeals process.

You will evaluate medical records, apply criteria, and determine benefit coverage while ensuring timeliness and regulatory compliance. Responsibilities include drug information support, literature documentation, and coordinating utilization reporting for client plans.