Registered Nurse Clinical Appeals Supervisor

Job Summary

A company is looking for a Clinical Appeals Supervisor to oversee clinical operations and manage appeals related to clinical denials.

Key Responsibilities

• Track and monitor the workflow of the clinical team to ensure compliance with deadlines
• Perform regular audits of appeals to evaluate productivity and quality, reporting on outcomes
• Assess cases for external review and make final determinations on clinical appeals

Required Qualifications

• Active Registered Nurse license
• Experience supervising in a clinical inpatient environment
• Conceptual knowledge of the denials landscape
• Proficiency in basic computer skills
• Ability to use sound judgment in reviewing clinical documentation