NY State Licensed Clinical Appeals Manager
Job Summary
Providing strategic and operational leadership, the full-time remote NY State Licensed Clinical Appeals Manager will oversee the Clinical Appeals & Grievances function, ensuring compliance and efficiency in case reviews while leading internal teams and optimizing workflows.
Key responsibilities
- Oversee daily operations and monitor productivity, quality, and operational performance
- Ensure compliance with all regulatory and organizational requirements for Appeals and Grievances processes
- Lead and develop teams to achieve performance and operational goals while standardizing workflows and implementing best practices
Required qualifications
- Bachelor's degree from an accredited institution or equivalent work experience
- RN or LPN license
- Experience in utilization management or appeals and grievance processing
- Understanding of healthcare payer operations and regulatory compliance
- Proven success in driving high performance and quality outcomes in a regulated environment
Complete Job Description
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