Clinical Appeals & Grievances Specialist

Healthfirst is seeking a qualified specialist responsible for developing and resolving clinical cases such as pre-existing conditions and prior approvals. The role entails research, regulation interpretation, and effective communication with colleagues. Ideal candidates should be RN, LPN, or Dental Hygienist with a bachelors degree preferred. Strong clinical experience and knowledge of utilization review guidelines are needed. Join a dynamic team committed to quality care. #J-18808-Ljbffr