Remote Lead Clinical Appeals Coordinator

centene; Washington; Remote; USD 46,000 - 84,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Job summary

Centene is seeking a remote Appeals Liaison to oversee statewide appeals, fair hearings, and related external processes. You will ensure all appeal letters meet State and NCQA requirements and coordinate with Medical Directors to justify medical determinations.

WA licensure is required and experience in appeals or utilization review is preferred. The role offers a remote schedule with standard business hours and a strong focus on compliance, reporting, and process improvement within a managed

Qualifications

• RN or LPN/LVN with required years in clinical nursing or case management.
• Experience with Managed care, Case Management or Utilization Review.

Responsibilities

• Review clinical information for appeals to determine medical necessity.
• Prepare reviews for cases not meeting criteria.
• Gather and report information on member and provider appeals.
• Prepare compliant response letters per state and NCQA standards.
• Coordinate with Medical Directors to clarify determinations.

Skills

Appeals experience

Lead experience

Education

RN license

LPN/LVN license

Job description

Centene is seeking a remote Appeals Liaison to oversee statewide appeals, fair hearings, and related external processes. You will ensure all appeal letters meet State and NCQA requirements and coordinate with Medical Directors to justify medical determinations.

WA licensure is required and experience in appeals or utilization review is preferred. The role offers a remote schedule with standard business hours and a strong focus on compliance, reporting, and process improvement within a managed