Clinical Appeals RN Supervisor

Job Summary

Overseeing a team of Registered Nurses, the full-time Clinical Appeals RN Supervisor will manage clinical denials, appeal reviews, and payer dispute resolutions while providing operational leadership and quality oversight in a remote setting.

Key Responsibilities

• Supervise, mentor, and develop a team of Clinical Appeals and Denials RNs while monitoring productivity and compliance metrics
• Oversee the review and management of medical necessity and clinical validation denials, ensuring timely appeal submissions
• Analyze denial trends and collaborate with various departments to implement denial prevention strategies and improve financial outcomes

Required Qualifications

• Active Registered Nurse (RN) license in good standing
• Minimum of 5 years of clinical nursing experience
• Minimum of 3 years of experience in clinical appeals, denials management, or utilization management
• Strong knowledge of InterQual, MCG, and payer guidelines
• Previous leadership or supervisory experience preferred