Manager, Clinician Appeals
New
USFull-TimeManager
Salary not disclosed
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Job Details
- Experience
- Minimum of 8 years of clinical experience, including at least 5 years in leadership roles related to appeals, utilization management, CDI, or revenue cycle management.
- Required Skills
- Quality Assurance
Requirements
- Active RN, MD, or DO license required; unrestricted medical license preferred.
- Minimum of 8 years of clinical experience.
- Minimum of 5 years in leadership roles related to appeals, utilization management, CDI, or revenue cycle management.
- Strong understanding of payer appeals processes, healthcare regulations, clinical documentation standards, and denial management.
- Proven experience leading high-volume clinical teams in fast-paced and matrixed environments.
- Demonstrated success building QA programs and improving operational workflows and clinical performance.
- Knowledge of DRG coding, CDI best practices, and payer denial trends is highly desirable.
- Experience working with both domestic and offshore/global teams preferred.
- Excellent leadership, communication, analytical, and stakeholder management skills.
Responsibilities
- Lead and develop clinical appeals teams responsible for drafting and reviewing high-quality payer appeal communications.
- Oversee hiring, onboarding, coaching, performance management, and ongoing development of domestic and global clinical staff.
- Establish and maintain quality assurance programs to ensure clinical accuracy, consistency, compliance, and effectiveness of appeal letters.
- Monitor operational performance metrics, overturn rates, productivity standards, and workflow efficiency to support organizational goals.
- Collaborate with administrative operations and leadership teams to align staffing, case volumes, and financial objectives.
- Analyze denial trends, identify root causes, and provide actionable recommendations to improve documentation and reduce future denials.
- Serve as a clinical subject matter expert during client meetings, escalations, education sessions, and strategic initiatives.
- Drive continuous improvement efforts focused on operational scalability, workflow optimization, and service excellence.
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