NY State Licensed Clinical Appeals Manager

Job Summary

A company is looking for a Manager of Clinical Appeals and Grievances.

Key Responsibilities

• Manage a team of specialists, overseeing productivity, coaching, and performance management
• Ensure timely resolution of cases and provide guidance on case preparation for reviews and appeals
• Identify operational challenges and implement process improvements to meet compliance and quality targets

Required Qualifications

• Bachelor's degree or equivalent work experience
• Registered Nurse (RN) certification
• Experience in utilization management or appeals and grievance processing
• Proven ability to manage multiple priorities in a fast-paced environment
• Experience in preparing and delivering information to diverse audiences