Texas Licensed Clinical Appeals Coordinator

A company is looking for a Clinical Appeals Coordinator.

Key Responsibilities

Act as the liaison for statewide appeals, ensuring compliance with State and NCQA requirements

Review clinical information and prepare reviews for cases that did not meet medical necessity criteria

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 preferred

Current state license as an RN, LPN, or LVN

Master's degree in a specialty therapy area or equivalent experience for specific therapy roles

Current state license in Physical Therapy, Occupational Therapy, or Speech-Language Therapy as applicable