Clinical Appeals Coordinator

Company: Superior HealthPlan | Location: Remote-DE | Salary: $34 to $61 per hour | Employment: Full-time | License: Multiple | State licensure: Not Specified

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: This is a fully remote, work-from-home position open to candidates in the Eastern and Central time zones. The standard schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m. ET, with some flexibility based on location. Candidates must hold an active RN license in any U.S. state; a compact license is preferred but not required. • 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 an