Location
Baltimore
Job Type
Full-time
Posted
July 04, 2026
Job Description
**Resp & Qualifications**
**PURPOSE:**
The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider appeals regarding adverse coverage decisions and grievances. The Clinical Appeals Nurse utilizes clinical skills and knowledge of all applicable State and Federal rules and regulations that govern the appeal process for Government Program lines of business to formulate a professional written response to the appeal or grievance request. We are looking for experienced clinicians to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities.
**ESSENTIAL FUNCTIONS:**
+ Investigates, interprets, and analyzes appeal (reconsideration) and grievance requests from multiple sources including members, authorized representatives, and providers. Responds to such requests in writing le...
**PURPOSE:**
The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider appeals regarding adverse coverage decisions and grievances. The Clinical Appeals Nurse utilizes clinical skills and knowledge of all applicable State and Federal rules and regulations that govern the appeal process for Government Program lines of business to formulate a professional written response to the appeal or grievance request. We are looking for experienced clinicians to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities.
**ESSENTIAL FUNCTIONS:**
+ Investigates, interprets, and analyzes appeal (reconsideration) and grievance requests from multiple sources including members, authorized representatives, and providers. Responds to such requests in writing le...