Oregon Licensed Clinical Appeals Coordinator

Job Summary

A company is looking for a Clinical Appeals Coordinator.

Key Responsibilities

• Act as the liaison for statewide appeals and ensure compliance with State and NCQA requirements
• Review clinical information and prepare response letters for member and provider clinical appeals
• Coordinate Fair Hearings and maintain current knowledge of NCQA and State regulations

Required Qualifications

• RN with 4+ years of clinical nursing and/or case management experience, or LPN with 5+ years of clinical nursing or case management experience
• Managed care or utilization review experience preferred
• LPN or Oregon RN nursing license required