Acting as the liaison for statewide appeals, the full-time Oregon Licensed Clinical Appeals Coordinator will review clinical information, prepare response letters, and ensure compliance with State and NCQA standards while working remotely. Key responsibilities Review clinical information for appeals to determine medical necessity of requested services Prepare response letters for member and provider clinical appeals, ensuring compliance with regulations Coordinate Fair Hearings and collaborate with Medical Directors on clinical determinations Required qualifications RN with 4+ years of clinical nursing or case management experience, or LPN/LVN with 5+ years of relevant experience Current Oregon RN, LPN, or LVN license Master's degree in a specialty therapy area or equivalent experience 3+ years of experience providing therapy services in healthcare or home health settings Managed care or utilization review experience preferred
Oregon Licensed Clinical Appeals Coordinator in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.