State Licensed Clinical Appeals Coordinator
Company: VirtualVocations
Location: Vista
Posted on: April 27, 2025
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Job Description:
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
Keywords: VirtualVocations, Orange , State Licensed Clinical Appeals Coordinator, Healthcare , Vista, California
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