Kansas Licensed Clinical Appeals Coordinator

Job Summary

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