Manager, Appeals Management
New
Based in United StatesFull-TimeManager
Salary not disclosed
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Job Details
- Experience
- Minimum of 8 years of clinical experience, including at least 5 years in a leadership role
- Required Skills
- LeadershipQuality Assurance
Requirements
- Active, unrestricted RN license required; compact license preferred.
- Minimum of 8 years of clinical experience, including at least 5 years in a leadership role within appeals, utilization management, CDI, or similar healthcare functions.
- Mandatory experience with DRG downgrade reviews and appeals.
- Strong understanding of payer appeals processes, healthcare regulations, documentation requirements, and denial management strategies.
- Proven experience managing high-performing clinical teams in a fast-paced operational environment.
- Experience developing quality assurance programs and improving clinical workflows.
- Knowledge of DRG coding, CDI practices, and payer denial trends preferred.
- Strong understanding of operational metrics, financial models, and revenue cycle performance indicators.
- Excellent communication, leadership, collaboration, and stakeholder management skills.
- Ability to work effectively in a remote, cross-functional, and constantly evolving environment.
- Willingness to travel occasionally for client meetings, industry events, or internal team gatherings.
Responsibilities
- Build, lead, and scale clinical appeal writing teams to support current and future client requirements.
- Oversee recruitment, onboarding, training, coaching, and performance management of clinical team members.
- Establish team structures, workflows, productivity expectations, and accountability standards.
- Manage clinical review and oversight processes to ensure appeal communications are accurate, compliant, and effective.
- Develop and enhance quality assurance programs to maintain clinical integrity, consistency, and documentation excellence.
- Monitor team performance metrics, including quality indicators, productivity measures, and appeal effectiveness outcomes.
- Align clinical operations with financial objectives, revenue targets, and key performance indicators.
- Partner with operational leadership to optimize case workflows and ensure timely delivery of client commitments.
- Analyze denial trends, identify root causes, and provide actionable recommendations to improve future outcomes.
- Participate in client meetings, escalations, and educational sessions by providing clinical expertise and strategic guidance.
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