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Clinical Denial Coordinator

Company: Cenpatico
Location: Little Rock
Posted on: March 25, 2020

Job Description:

Clinical Denial Coordinator USA-Arkansas-Little Rock Position Purpose: Act as the repository for all regional denial and appeal letters, be the liaison between Medical Management, Quality, NCQA and State requirements and responsible for ensuring that all denial and appeal letters generated by the health plan nurses, Medical Directors and regional locations comply with both state and NCQA requirements. * Audit and revise all denial and appeal letters for Superior Health Plan locations. * Ensure letters are compliant with NCQA standards. * Coordinate with Manager of Preauthorization & Referrals on training needs. * Coordinate with Medical Director(s) to clarify medical determinations or clinical rationale. * Act as liaison with the Quality Department to maintain current knowledge of NCQA and State regulations within the Medical Management Department. Education/Experience: Graduate from an accredited school of nursing. 3+ years of clinical nursing or case management experience. Managed care experience preferred. License/Certification: RN, LPN or LVN license. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Compliance Full-time

Keywords: Cenpatico, Little Rock , Clinical Denial Coordinator, Healthcare , Little Rock, Arkansas

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