Florida Licensed Clinical Appeals Manager

Job Summary

Leading clinical appeals operations remotely, the Florida Licensed Clinical Appeals Manager will oversee a team of clinical appeal specialists, manage the full-cycle clinical appeals process across various payers, and ensure compliance with regulatory standards.

Key Responsibilities

• Manage the full-cycle clinical appeals process for government and commercial payers
• Lead and support a team of nurses and appeal specialists, including offshore staff
• Monitor workloads and productivity to meet appeal deadlines and client service level agreements

Required Qualifications

• Registered Nurse (RN) or clinical degree required; Bachelor's degree preferred
• 5+ years of experience in clinical appeals or medical necessity denials
• 2+ years in a leadership role within a revenue cycle or payer appeals setting
• In-depth understanding of payer denial processes, particularly Medicare and Medicaid
• Experience managing remote and/or offshore teams, preferably with Philippines experience