Clinical Coordinator

Hybrid in Florida City, FL, US • Posted 11 hours ago • Updated 11 hours ago
Contract Independent
Contract W2
6 Months
No Travel Required
Remote
Depends on Experience
Fitment

Dice Job Match Score™

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Job Details

Skills

  • Medical Records
  • Nursing
  • Medicare
  • ICD-10

Summary

 

Avanciers Incorporated is hiring a Clinical Coordinator for one of our clients.

Role: Clinical CoordinatorLocation: Florida / Remote (as applicable)Experience: 1–5 years of clinical nursing experienceRequired License: Active, unrestricted Florida RN License or Compact RN LicenseJob Description:
  • Reviews and investigates member and provider appeals involving clinical/medical necessity denials.
  • Analyzes medical records, claims history, and clinical documentation against InterQual/MCG criteria to determine appeal outcomes.
  • Ensures timely resolution in accordance with CMS, NCQA, Medicare, Medicaid, and state regulatory requirements.
  • Documents clinical rationale and coordinates with Medical Directors on complex cases.
Qualifications:
  • Active, unrestricted Florida RN License or Compact RN License
  • 1–5 years of clinical nursing experience
  • 1–2 years of experience in Utilization Review, Case Management, or Appeals/Grievances within a managed care/health plan setting
  • Strong knowledge of medical terminology and ICD-10/CPT coding basics
  • Experience with medical necessity review and InterQual/MCG criteria
  • Knowledge of CMS, NCQA, Medicare/Medicaid regulatory requirements
Good to Have ExperienceManaged Medicaid/Medicare Advantage experience; prior health plan UM/UR background; experience with appeal turnaround SLAs
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
  • Dice Id: 91094911
  • Position Id: 9109431
  • Posted 11 hours ago
Contact the job poster
PS

Pranav Seth

Recruiter @ Avanciers LLC
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