Remote RN Clinical Appeals Specialist

Yoh Services LLC; Philadelphia (Philadelphia County); Remote; USD 43,000 - 62,000; Full time

Benefits offered by this job

Medical, Prescription, Dental & Vision

Health Savings Account (HSA)

Life & Disability Insurance

401K Retirement Savings Plan

Direct Deposit & weekly epayroll

Certification and training

Job summary

Yoh Services LLC is seeking a Remote-Clinical Appeals Coordinator (RN) to support our client’s clinical appeals team from a remote location in Pennsylvania, New Jersey, or Delaware. The role demands strong clinical judgment, utilization management knowledge, and meticulous documentation.

You will review medical records, interpret benefits, and coordinate with medical directors and reviewers to drive accurate, compliant appeal determinations.

Qualifications

• Active Registered Nurse (RN) license required (Pennsylvania RN license or compact license with PA eligibility).
• Minimum of 5 years of clinical nursing experience.
• Experience in Utilization Management, Prior Authorization, or related areas is a plus.

Responsibilities

• Review and manage clinical appeals from intake through final resolution.
• Evaluate medical records, benefit information, prior authorizations, denial rationale, and supporting clinical documentation.
• Apply clinical nursing knowledge and utilization management principles to support appeal determinations.
• Coordinate with Medical Directors, physician reviewers, and cross-functional teams on complex cases.
• Prepare case summaries and ensure all appeal documentation is complete and audit-ready.
• Support member and provider communications related to appeal outcomes.
• Monitor appeal timelines to ensure compliance with state, federal, and accreditation requirements.
• Identify trends, process improvements, and quality enhancement opportunities.
• Participate in training, audits, calibration sessions, and continuous improvement initiatives.

Skills

RN

Education

BSN

Job description

Yoh Services LLC is seeking a Remote-Clinical Appeals Coordinator (RN) to support our client’s clinical appeals team from a remote location in Pennsylvania, New Jersey, or Delaware. The role demands strong clinical judgment, utilization management knowledge, and meticulous documentation.

You will review medical records, interpret benefits, and coordinate with medical directors and reviewers to drive accurate, compliant appeal determinations.