Appeals Clinician I
Portland, Oregon - Added Mar 26th, 2026
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Clinical Appeals Specialist (REMOTE)
Motus is partnering with a leading healthcare provider to identify an experienced Clinical Appeals Specialist for a contract opportunity. The Clinical Appeals Specialist applies clinical expertise to conduct the clinical component of members and provider appeals. The role ensures that appeal determinations comply with medical policy, clinical guidelines, federal and state regulations, and industry standards. The clinician consults with physician advisors as needed and provides guidance to non-clinical appeals staff. This is a remote, contract-only position.
Contract duration: 6 -Months
Location: Portland, OR
100% Remote: Must reside within OR, WA, ID, or UT
Hourly Pay Range: $26.00 - $28.75
Benefit eligibility: Yes
Schedule:
Responsibilities of a Clinical Appeals Specialist:
Qualifications of a Clinical Appeals Specialist:
**We are unable to accommodate corp. to corp. candidates**
About Motus Recruiting and Staffing, Inc:
Founded in 2006, Motus is an award-winning recruiting and staffing firm in the Pacific Northwest, specializing in professional services and technology solutions. We are a group of people who not only recognize the importance of representation, but actively fight for diversity, equity, and inclusion in the recruitment process. Our goal is to educate organizations on the importance of DEI when hiring, promoting, and supporting diverse employees. We are calling organizations to demonstrate their commitment to DEI by being intentional about who they hire. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, citizenship, disability or protected veteran status.
PG/BH 13909
Motus is partnering with a leading healthcare provider to identify an experienced Clinical Appeals Specialist for a contract opportunity. The Clinical Appeals Specialist applies clinical expertise to conduct the clinical component of members and provider appeals. The role ensures that appeal determinations comply with medical policy, clinical guidelines, federal and state regulations, and industry standards. The clinician consults with physician advisors as needed and provides guidance to non-clinical appeals staff. This is a remote, contract-only position.
Contract duration: 6 -Months
Location: Portland, OR
100% Remote: Must reside within OR, WA, ID, or UT
Hourly Pay Range: $26.00 - $28.75
Benefit eligibility: Yes
Schedule:
- Must be able to work PST hours.
- May require availability for evenings, weekends, holidays, and overtime as needed
Responsibilities of a Clinical Appeals Specialist:
- Conduct clinical reviews of appeals in accordance with member benefits, provider contracts, and medical necessity guidelines.
- Apply clinical judgment to ensure compliance with medical policy, reimbursement policies, and accepted standards of care.
- Consult with physician advisors to ensure clinically appropriate determinations.
- Advise and educate non-clinical appeals staff on clinical cases.
- Review and interpret medical records, patient data, and member benefits; communicate findings effectively.
- Prepare clear, concise written appeal narratives and decisions.
- Apply knowledge of CPT, ICD-9/10, HCPCS coding, and Milliman Care Guidelines (MCG).
- Collaborate with internal teams and external partners to resolve discrepancies or issues.
Qualifications of a Clinical Appeals Specialist:
- BA degree in Nursing or health/human services field AND 2+ years of experience in health insurance, utilization management, or clinical appeals review.
- Familiarity with medical and surgical procedures, billing, and claims processes.
- Clinical experience (minimum 3 years, or full-time equivalent) in direct patient care.
- Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint, Access).
**We are unable to accommodate corp. to corp. candidates**
About Motus Recruiting and Staffing, Inc:
Founded in 2006, Motus is an award-winning recruiting and staffing firm in the Pacific Northwest, specializing in professional services and technology solutions. We are a group of people who not only recognize the importance of representation, but actively fight for diversity, equity, and inclusion in the recruitment process. Our goal is to educate organizations on the importance of DEI when hiring, promoting, and supporting diverse employees. We are calling organizations to demonstrate their commitment to DEI by being intentional about who they hire. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, citizenship, disability or protected veteran status.
PG/BH 13909
Job ID: 13909
