Tennessee Licensed Clinical Appeals Supervisor

Job Summary

Overseeing the coordination of audit and medical necessity denial appeals, the full-time Tennessee Licensed Clinical Appeals Supervisor will manage a team to ensure timely and accurate submissions, compliance with regulatory standards, and achievement of service goals in a remote setting.

Key responsibilities

• Supervises the team responsible for preparing and submitting medical necessity denial appeals while ensuring compliance with established timelines
• Monitors team performance and ensures timely communication with Recovery Audit Contractors (RACs) and other auditors
• Identifies denial trends and compliance risks, reporting findings to senior leadership and providing training to team members

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