Director of Appeals

Job Summary

A company is looking for a Director of Appeals to lead and manage the clinical appeals function within the Utilization Management department.

Key Responsibilities

• Develop and implement strategic plans for the clinical appeals program
• Lead a team in managing appeals and grievances, ensuring compliance with regulatory standards
• Oversee the end-to-end appeals process and monitor performance metrics for continuous improvement

Required Qualifications

• Professional designation as RN, NP, or CEBS preferred
• Minimum 7 years of healthcare experience, with at least 3 years in utilization management or appeals
• Strong knowledge of InterQual and payer policies
• Proven leadership experience in a healthcare setting
• Experience with electronic medical record systems and utilization management platforms preferred