Clinical Appeals Coordinator
Centene Corporation
Posted: 10/21/2026
Clinical Coordinator
Star Sleep & Wellness
Posted: 10/21/2026Clinical Quality Coordinator, RN
Centene Corporation
Posted: 10/16/2026
Advocacy Clinical Review Coordinator I/II/III
LTHC
Posted: 10/15/2026
Senior Field Clinical Coordinator – LSD FCC
BioMarin Pharmaceutical Inc.
Posted: 10/15/2026SFDC
Clinical Coding Retrieval Coordinator
Healthfirst
Posted: 10/14/2026SOAP
Clinical Coordinator – MnSCU Academic Professional 3
Minnesota State Moorhead
Posted: 10/14/2026
Clinical Placement Coordinator
Cizik School of Nursing at UTHealth Houston
Posted: 10/13/2026Cloud
Dietetic Internship Coordinator – Clinical Nutrition Services
McLeod Health
Posted: 10/13/2026Clinical Appeals Coordinator
Centene Corporation
Posted: 10/12/2026Clinical Appeals Coordinator
Centene Corporation
Posted: 10/7/2026
Clinical Partnership Coordinator
Vanderbilt University Medical Center
Posted: 10/7/2026Lead Clinical Appeals Coordinator
Centene Corporation
Posted: 10/7/2026
Clinical Policy and Practice Coordinator
Baystate Health
Posted: 10/6/2026
Clinical Education Program Coordinator – Rehabilitation
Emory University
Posted: 10/5/2026Clinical Education Program Coordinator – Rehabilitation
Emory University
Posted: 10/5/2026
Utilization Management Clinical Coordinator
Progyny, Inc.
Posted: 10/2/2026
Prior Authorization Clinical Criteria – Policy Coordinator
TrueScripts Management Services
Posted: 10/2/2026
Clinical Coordinator – RN Supervisor
DaVita Kidney Care
Posted: 9/30/2026
Dialysis Clinical Coordinator, RN
Rendevor Dialysis
Posted: 9/29/2026Clinical Appeals Coordinator
Centene CorporationCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical nursing and case management, with a strong focus on appeals processes and compliance with NCQA and state regulations. Proficient in analyzing clinical information and preparing documentation for medical necessity determinations.
Highest-signal resume keywords
RN LicenseClinical Nursing ExperienceCase Management ExperienceUtilization Review ExperienceNCQA Compliance
About the role
Key responsibilities & impact- Act as liaison for statewide appeals, fair hearings, review organizations, and other external appeals
- Ensure appeal letters comply with State and NCQA requirements
- Review clinical information using nationally recognized criteria to determine medical necessity
- Prepare reviews for cases that did not meet criteria
- Gather, analyze, and report verbal and written information regarding member and provider clinical appeals
- Follow up on appeal information
- Prepare response letters for member and provider clinical appeals
- Maintain files and logs for all appeals
- Coordinate with Medical Directors to clarify medical determinations or clinical rationale
- Maintain current knowledge of NCQA and State regulations
- Coordinate Fair Hearings with internal departments and agencies
- Perform other duties as assigned
- Comply with all policies and standards
Requirements
What you’ll need- 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
- LPN, LVN, or RN license
- Texas: RN license required within Utilization Management at Superior HealthPlan or LPC, LCSW, or Psy.D. licensure within UM Behavioral Health Appeals team
- Specialty Therapy: Master’s degree in area of specialty therapy or equivalent experience
- Specialty Therapy: 3+ years of experience providing therapy services in healthcare or home health settings
- Specialty Therapy: Current state license in Physical Therapy, Occupational Therapy, or Speech-Language Therapy
- Speech-Language Therapist: active Certificate of Clinical Competence from the American Speech-Language-Hearing Association
- Corporate & Louisiana Healthcare Connections: current state RN, LPN, or LVN, LPC, LCSW, or Psy.D. license
Benefits
Comp & perks- Competitive pay
- Health insurance
- 401K plan
- Stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
- Additional forms of incentives may be included in total compensation
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical Information ReviewMedical Necessity DeterminationAppeal Letter PreparationData AnalysisDocumentation Management
Soft Skills
CommunicationCoordinationAttention to Detail
Certifications & Qualifications
Certificate of Clinical CompetenceState RN LicenseState LPN LicenseState LVN License
Industry Keywords
Managed CareUtilization ManagementFair HearingsHealthcare RegulationsClinical Appeals