State Licensed Clinical Appeals Coordinator

A company is looking for a Clinical Appeals Coordinator. Key Responsibilities Act as a liaison for statewide appeals and ensure compliance with State and NCQA requirements Review clinical information to determine medical necessity and prepare response letters for appeals Maintain files, logs, and coordinate Fair Hearings with internal departments and agencies Required Qualifications RN with 4+ years of clinical nursing or case management experience, or LPN/LVN with 5+ years of experience Managed care or utilization review experience preferred Current state RN, LPN, or LVN license required Knowledge of NCQA and State regulations Experience in clinical appeals processes

Apr 9, 2025 - 03:52

A company is looking for a Clinical Appeals Coordinator. Key Responsibilities Act as a liaison for statewide appeals and ensure compliance with State and NCQA requirements Review clinical information to determine medical necessity and prepare response letters for appeals Maintain files, logs, and coordinate Fair Hearings with internal departments and agencies Required Qualifications RN with 4+ years of clinical nursing or case management experience, or LPN/LVN with 5+ years of experience Managed care or utilization review experience preferred Current state RN, LPN, or LVN license required Knowledge of NCQA and State regulations Experience in clinical appeals processes