Washington State Licensed Clinical Appeals Coordinator

Job Summary

A company is looking for a Clinical Appeals Coordinator to manage statewide appeals and ensure compliance with regulations.

Key Responsibilities

• Act as the liaison for statewide appeals and ensure compliance with State and NCQA requirements
• Review clinical information to determine medical necessity for appeals and prepare response letters
• Coordinate Fair Hearings and maintain files and logs for all appeals

Required Qualifications, Training, and Education

• 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 is preferred
• Current state license as an RN, LPN, or LVN is required
• Master's degree in specialty therapy or equivalent experience, if applicable
• Current state license in Physical Therapy, Occupational Therapy, or Speech-Language Therapy, if applicable