Clinical Appeals Coordinator

Job Description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management / Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

• Remote position. Pacific Standard Time is strongly preferred
• Must have a current RN or LPN Oregon state license
• Utilization review, case management, and appeals experience in a managed care setting is strongly preferred

Position Purpose :

Act as the liaison for all statewide appeals, fair hearings, review organizations, and other external type appeals. Responsible for ensuring that all appeal letters generated comply with both State and NCQA requirements.

Education / Experience :

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.

License / Certification : LPN, LVN, or RN license.

Texas Requirements : RN license required within Utilization Management at Superior HealthPlan or LPC, LCSW or Psy D. licensure within UM Behavioral Health Appeals team.

Specialty Therapy Requirement : Master’s degree in area of specialty therapy or equivalent experience. 3+ years of experience providing therapy services in healthcare or home health settings. Managed care or utilization review experience preferred.

Licenses / Certifications : Current state license in Physical Therapy, Occupational Therapy or Speech-Language Therapy. Speech-Language Therapist must have an active Certificate of Clinical Competence from the American Speech-Language-Hearing Association.

Corporate & Louisiana Healthcare Connections Requirements : Current state RN, LPN, or LVN, LPC, LCSW, or Psy.D license.

Pay Range : $33.03 - $59.47 per hour

Centene offers a comprehensive benefits package including : competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act