Clinical Appeals Coordinator (Healthcare)

Location: Fully remote within the United States; open to candidates in the Eastern or Central time zones. Standard schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m. ET, with some flexibility based on location.

Salary: $33.71–$60.67 per hour

Company

hirify.global connects people with healthcare services and works to make care more accessible and effective.

What you will do

• Act as a liaison for statewide appeals, fair hearings, review organizations, and other external appeals.
• Review clinical information using nationally recognized criteria to determine medical necessity.
• Prepare case reviews and response letters for member and provider appeals.
• Ensure appeal correspondence complies with State and NCQA requirements.
• Maintain appeal files and logs and gather, analyze, and report clinical information.
• Coordinate with Medical Directors, internal departments, and external agencies regarding determinations and fair hearings.

Requirements

• Active LPN, LVN, or RN license in any U.S. state is required; a compact license is preferred but not required.
• RN with at least 4 years of clinical nursing or case management experience, or LPN/LVN with at least 5 years of such experience.
• Ability to work within the Eastern or Central time zones.
• Knowledge of clinical review, medical necessity, appeal processes, and regulatory requirements.
• Ability to maintain accurate records and coordinate with Medical Directors and multiple departments.

Nice to have

• Managed care experience.
• Utilization review experience.
• Compact nursing license.

Culture & Benefits

• Health insurance and comprehensive employee benefits.
• 401(k) and stock purchase plans.
• Tuition reimbursement.
• Paid time off and holidays.
• Flexible work approach with remote, hybrid, field, or office schedules across the organization.