Manager, Clinician Appeals, Active RN License Required

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🕒 4 dias atrás

🇺🇸 Estados Unidos – Remoto (EUA)

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CorroHealth

SiteLinkedInTodas as Vagas

5001 - 10000 funcionários

⚕️ Seguro de Saúde

☁️ SaaS

🤖 Inteligência Artificial

Healthcare Insurance • SaaS • Artificial Intelligence

CorroHealth é um provedor líder de análises de saúde clinicamente orientadas e soluções impulsionadas por tecnologia, focado em melhorar o desempenho financeiro de hospitais e sistemas de saúde. Suas soluções integradas e tecnologias avançadas visam otimizar todo o ciclo de receita, oferecendo serviços como gestão do ciclo de receita, documentação clínica, codificação médica e gestão de recusas. Com um compromisso de melhorar a saúde financeira por meio de tecnologia inteligente e orientação especializada, a CorroHealth aborda complexas relações entre pagadores e prestadores e apoia operações de saúde eficientes.

Descrição

• The Manager of Clinician Appeals is responsible for the strategic oversight and operational execution of the appeals letter writing and client education engagement. • Lead high-performing clinical teams in the development of clinically accurate, persuasive, and compliant appeal communications to payers. • Ensure operational excellence, clinical integrity, and alignment with financial goals. • Work closely with internal leadership, administrative operations, and external clients to ensure best-in-class service delivery. • Build, lead, and scale the clinical letter writing team, ensuring appropriate staffing levels aligned to current and forecasted client demand. • Oversee hiring, onboarding, training, and performance management of clinical writers. • Define and implement the team’s leadership structure and workflows. Enforce quality and productivity standards. • Develop and continuously improve robust QA programs ensuring appeal content meets or exceeds clinical accuracy, appropriateness, and grammatical standards. • Understand the appeals financial model and associated KPIs; align clinical operations to meet or exceed revenue and margin targets. • Identify and champion process improvement and efficiency initiatives to increase clinical team productivity without compromising quality.

🎯 Requisitos

• RN, MD or DO license required; active, unrestricted medical license (any state) preferred. • Minimum 8+ years of clinical experience with at least 5 years in a leadership role within appeals, utilization management, clinical documentation improvement (CDI), or similar RCM functions. • DRG Downgrade experience is mandatory. • Strong knowledge of payer appeals processes, healthcare regulations, and documentation standards. • Demonstrated success in managing clinical teams in a high-volume, fast-paced environment. • Proven experience developing QA programs and implementing clinical workflow improvements. • Strong understanding of financial models and operational KPIs in the revenue cycle industry. • Exceptional communication, collaboration, and leadership skills.

🏖️ Benefícios

• Competitive annual salary • Medical/Dental/Vision Insurance • Equipment provided • 401k matching program • FTO: Flex Unlimited Annual PTO • Paid Paternity & Maternity leave programs • 9 paid annual holidays • Life Insurance • Long term disability • Short term disability options • Tuition reimbursement and much more!