RN Clinical Appeals Manager

Job Summary

A company is looking for a Clinical Appeals & Denials Manager who will oversee clinical appeals and denials management for client hospitals.

Key Responsibilities

• Oversee department supervisors and manage overall department vision
• Review denial reports, identify trends, and implement corrective actions
• Manage the appeals process and ensure compliance with payer policies

Required Qualifications, Training, and Education

• Prior leadership experience in a high-volume inventory management setting
• Experience with medical record reviews or clinical denial management
• Active RN license preferred
• Ability to develop and maintain policies and procedures for denials and appeals management
• Experience in preparing and presenting reports on denials and appeals metrics