Louisiana Licensed RN Appeals Coordinator

Job Summary

A company is looking for an RN Clinical Appeals Coordinator.

Key Responsibilities

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

Required Qualifications, Training, and Education

• 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 state RN, LPN, or LVN license required
• Applicants must reside in LA