New York Licensed Clinical Appeals Manager

Job Summary

Managing appeal inventory for a team of Clinical Specialists, the full-time New York Licensed Clinical Appeals Manager will work weekends and focus on ensuring compliance, optimizing appeal routing, and maintaining vendor relationships in a remote environment.

Key responsibilities:

• Prepare and assign weekend staff's tasks to ensure compliance and manage appeal inventory
• Triage expedited appeals and standardize routing processes for efficiency
• Communicate with medical peer reviewers and coordinate case escalations for resolution

Required qualifications:

• High School Diploma or GED
• Proven experience in appeals and grievances or a healthcare environment
• Ability to work a weekend schedule (Fri-Mon or Thurs-Sun)
• Experience with Microsoft Word, Excel, and care management systems
• Strong organizational skills in a fast-paced environment with multiple priorities