Indiana Licensed Clinical Appeals Manager

Job Summary

Overseeing all clinical appeals activities, the full-time Indiana Licensed Clinical Appeals Manager will ensure compliance with regulatory requirements, manage the clinical appeals process, and interact with providers to uphold state-based regulations in a remote work environment.

Key responsibilities

• Coordinate and manage the clinical appeals process related to adverse benefit determinations
• Monitor productivity and turnaround times while ensuring compliance with industry standards
• Analyze data related to clinical appeals and formulate recommendations for quality of care improvements

Required qualifications

• Current, unrestricted licensure as a Registered Nurse (RN) in the state of practice
• Associate's Degree in Nursing required; Bachelor's of Science in Nursing (BSN) preferred
• Minimum of five (5) years of clinical experience required
• Minimum of five (5) years of experience in utilization management, appeals, and/or quality improvement
• Preferred experience includes two (2) years in a leadership role and managed care leadership experience