Lead Clinical Appeals Coordinator

Location: Remote in Washington State; Monday-Friday, 8:00 am-5:00 pm PST

Salary: $33.71-$60.67 per hour

Company

hirify.global provides healthcare services focused on connecting people with accessible care and improving health outcomes.

What you will do

• Coordinate statewide appeals, fair hearings, external review organizations, and related appeal activities.
• Review clinical information and apply nationally recognized criteria to determine medical necessity.
• Prepare case reviews and response letters for member and provider appeals in compliance with State and NCQA standards.
• Coordinate with medical directors, internal departments, agencies, and providers to clarify clinical rationales and manage fair hearings.
• Facilitate training, auditing, escalations, policy reviews, and implementation of new processes.
• Prepare recurring denial and appeal reports and coordinate departmental workflows and coverage.

Requirements

• RN with 4+ years of clinical nursing or case management experience, or LPN/LVN with 5+ years of clinical nursing or case management experience.
• Experience in managed care, case management, or utilization review.
• Current Washington State RN, LPN, or LVN license, or compact licensure, is required.
• Appeals experience and previous lead experience are strongly preferred.
• Ability to work Monday-Friday, 8:00 am-5:00 pm Pacific Time.

Culture & Benefits

• Remote work arrangement with a flexible approach to remote, hybrid, field, or office schedules across the organization.
• Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, and holidays.
• Work focused on improving access to healthcare for individuals, families, and communities.
• Equal opportunity workplace committed to diversity and inclusion.