Oregon Licensed Clinical Appeals Coordinator

A company is looking for a Clinical Appeals Coordinator.

Key Responsibilities

Act as a liaison for statewide appeals and ensure compliance with State and NCQA requirements

Review clinical information for appeals to determine medical necessity and prepare response letters

Coordinate Fair Hearings and maintain files and logs for all appeals

Required Qualifications

Valid RN or LPN license in the state of Oregon

RN with 4+ years of clinical nursing and / or case management experience, or LPN with 5+ years of experience

Managed care or utilization review experience preferred