Manager, Clinician Appeals, Active RN License Required

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🔥 13 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟠 Senior

🔴 Lead

👔 Manager

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CorroHealth

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

⚕️ Healthcare Insurance

☁️ SaaS

🤖 Artificial Intelligence

Healthcare Insurance • SaaS • Artificial Intelligence

CorroHealth is a leading provider of clinically led healthcare analytics and technology-driven solutions, focused on enhancing the financial performance of hospitals and health systems. Their integrated solutions and advanced technologies aim to optimize the entire revenue cycle, offering services such as revenue cycle management, clinical documentation, medical coding, and denials management. With a commitment to improving financial health through intelligent technology and expert guidance, CorroHealth addresses complex payer-provider relationships and supports efficient healthcare operations.

📋 Description

• 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.

🎯 Requirements

• 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.

🏖️ Benefits

• 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!