Acting as the liaison for statewide appeals, the full-time Kansas Licensed Clinical Appeals Coordinator will review clinical information, prepare compliant response letters, and coordinate fair hearings while working remotely. Key responsibilities Review clinical information for appeals to determine medical necessity using nationally recognized criteria Prepare response letters for member and provider clinical appeals, ensuring compliance with State and NCQA standards Coordinate with Medical Directors to clarify medical determinations and maintain logs for all appeals Required qualifications RN with 4+ years of clinical nursing and/or case management experience, or LPN/LVN with 5+ years of clinical nursing or case management experience Managed care or utilization review experience preferred Current LPN, LVN, or RN license
Kansas Licensed Clinical Appeals Coordinator in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.