Clinical Appeals Coordinator

Location: Remote in Oregon; Pacific Time Zone hours required.

Pay range: $33.71–$60.67 per hour.

Company

hirify.global provides healthcare services focused on connecting people with the care they need.

What you will do

• Act as the 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 letters comply with state and NCQA requirements.
• Gather, analyze, document, and report clinical appeal information while maintaining files and logs.
• Coordinate with Medical Directors, internal departments, and external agencies on determinations and fair hearings.

Requirements

• Unencumbered RN, LVN, or LPN license in Oregon required.
• RN: 4+ years of clinical nursing and/or case management experience.
• LPN/LVN: 5+ years of clinical nursing or case management experience.
• Maintain current knowledge of NCQA and state regulations.
• For specialty therapy cases: a master’s degree in the specialty therapy area or equivalent experience, plus 3+ years providing therapy services in healthcare or home health settings.

Nice to have

• Managed care or utilization review experience.

Culture & Benefits

• Health insurance, 401(k), and stock purchase plans.
• Tuition reimbursement, paid time off, and holidays.
• Flexible work approaches, including remote, hybrid, field, and office schedules.
• Compensation may vary based on skills, experience, education, and other job-related factors.