Clinical Appeals Coordinator

Company: Arizona Complete Health | Location: Remote-WI | Salary: $34 to $61 per hour | Employment: Full-time | License: Multiple | State licensure: Louisiana|Texas|Wisconsin

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. Key Details: Must be licensed in Wisconsin. Experience in healthcare, managed care, utilization management, appeals, grievances, case management, or related healthcare operations highly preferred. • Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of services requested. • Prepare reviews for cases that did not meet criteria • Gather, analyze and report verbal and written information regarding member and provider clinical appeals, including information follow up • Prepare response letters f