Clinical Appeals Manager

Job Summary

Managing appeal inventory for a team of Clinical Specialists, the full-time Clinical Appeals Manager will work remotely, focusing on compliance, triaging expedited appeals, and coordinating with various departments while ensuring high-quality output and adherence to regulatory standards.

Key responsibilities:

• Prepare and plan weekend staff assignments to ensure compliance
• Triage and assign expedited appeals while optimizing routing processes
• Maintain vendor relationships and ensure performance and compliance measures are met

Required qualifications:

• H.S. Diploma or GED
• Proven work experience in appeals and grievances or a healthcare environment
• Willingness and ability to work a weekend schedule (i.e., Fri-Mon or Thurs-Sun)
• Experience with various computer applications, including Microsoft Word and Excel
• Demonstrated ability to work independently in a fast-paced environment