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Clinical Coordinator

Avanciers LLCFlorida City, FL🇺🇸United StatesPosted Oct 8, 2026

Quick Overview

Seniority
Mid Senior
Work mode
Hybrid
Location
Florida City, FL, United States
Posted
21 hours ago
CPT CodingCase ManagementICD-10Medical TerminologyNursing

Job Description

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

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