New

Appeals Nurse

Spectraforce Technologies

$101,000

United States, Florida, Jacksonville

13141 City Station Drive (Show on map)

Sep 04, 2026

Position Title: Appeals Nurse

Assignment Duration: 7 months; potential to extend/convert

Work Location: Remote-FL

Work Schedule: M-F: 9a - 6p EST / Possible weekends (Saturdays- same as weekday schedule) Not required.No OT

Work Arrangement: Remote

FTE Salary Conversion Band

$101,000

Responsibilities:

Review medical records for medical necessity, using approved criteria application, to make recommendations for MD on appeal medical necessity reviews.

Receive assignments electronically via company applications and excel sheets, emails are also sometimes used for case communication. Review appeal requests, medical records, and apply applicable medical necessity criteria. Write up the appeal clinical review and forward to MD for review and final determination. Receive the case back post MD review for clinical closure and route to coordinator for case closure.
4-8 complete cases per day.
Ability to work remotely and self-directed to keep oneself at pace. Able to use clinical knowledge and experience to visualize the appeal request and get better understanding of clinical picture.

Candidate Requirements
Education/Certification	Required: Nursing certification/degree	Preferred:
Licensure	Required: RN or LPN FL Licensure Required	Preferred: N/A
Years of experience required: At least 3 years in a clinical setting followed by at least 1 year experience in managed care/ utilization management setting such as prior authorization clinical reviewer; appeals clinical reviewer a plus/preferred. Disqualifiers: Less than 1 year or no managed care / utilization management experience. Additional qualities to look for: Experience using InterQual criteria application, Also, candidate who in addition to clinical physical health experience has experience in clinical mental health care.
Top 3 must-have hard skills stack-ranked by importance	1	Clinical utilization management experience - clinical reviews
2	InterQual criteria application
3	Able to work independently

Position is offered by a no fee agency.