Remote Clinical Appeals Coordinator (RN/LPN)

Centene; Nebraska; A distancia; USD 46.000 - 84.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules (remote,hybrid

Flexible work schedules (remote, field

Descripción de la vacante

Centene is seeking a Clinical Appeals Coordinator to act as the statewide liaison for appeals, ensuring NCQA and state compliance. Ideal for clinicians with case management experience who are detail-oriented and skilled in communication.

This remote role in Nebraska supports a full-time day schedule, collaborating with Medical Directors and internal teams to maintain compliance and drive timely outcomes. The position emphasizes review of medical necessity, preparation of appeal responses, and

Formación

• RN with 4+ years of clinical nursing and/or case management experience.
• LPN/LVN with 5+ years of clinical nursing or case management experience.
• Current state license as LPN, LVN, or RN.

Responsabilidades

• Act as the liaison for all statewide appeals and fair hearings.
• Review clinical information for all appeals to determine medical necessity.
• Prepare reviews for cases that did not meet criteria.
• Gather, analyze, and report information regarding member and provider clinical appeals.
• Prepare response letters for appeals ensuring compliance with standards.
• Maintain files and logs for all appeals.
• Coordinate with Medical Director(s) to clarify medical determinations.
• Maintain current knowledge of NCQA and State regulations.
• Coordinate Fair Hearings with various internal departments and agencies.
• Comply with all policies and standards.

Conocimientos

Clinical nursing

Case management

Communication

Detail-oriented

Educación

RN with 4+ years of clinical nursing or case management

LPN/LVN with 5+ years of clinical nursing or case management

Descripción del empleo

Centene is seeking a Clinical Appeals Coordinator to act as the statewide liaison for appeals, ensuring NCQA and state compliance. Ideal for clinicians with case management experience who are detail-oriented and skilled in communication.

This remote role in Nebraska supports a full-time day schedule, collaborating with Medical Directors and internal teams to maintain compliance and drive timely outcomes. The position emphasizes review of medical necessity, preparation of appeal responses, and