RN Licensed Clinical Appeals Supervisor

Job Summary

Overseeing the coordination of audit and medical necessity denial appeals, the full-time remote RN Licensed Clinical Appeals Supervisor will manage a team to ensure timely submissions, compliance with regulatory standards, and the achievement of service goals while providing leadership and developing standardized processes.

Key Responsibilities

• Supervises the team in reviewing, preparing, and submitting medical necessity denial appeals according to established processes
• Ensures timely communication with auditors and manages documentation requests and appeal submissions
• Monitors team performance for compliance with regulatory requirements and provides training on appeals processes

Required Qualifications

• H.S. Diploma or GED required
• Associate Degree in Nursing, Healthcare Administration, or a related field preferred
• 3-5 years of experience in healthcare appeals or denials management required
• 1-2 years of leadership or supervisory experience preferred
• RN - Registered Nurse - State Licensure and/or Compact State Licensure preferred