Manager, Clinician Appeals in United States at Jobgether

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Manager, Clinician Appeals in United States.

This leadership role offers the opportunity to shape and optimize clinical appeals operations within a fast-paced healthcare revenue cycle environment. The position focuses on leading high-performing clinical teams responsible for creating persuasive, compliant, and clinically accurate appeal communications that improve reimbursement outcomes. You will work closely with executive stakeholders, physicians, hospital leaders, and operational teams to drive quality, efficiency, and strategic process improvements. This role combines clinical expertise, operational oversight, and people leadership, making it ideal for a professional who thrives in collaborative and evolving healthcare settings. In addition to managing workflows and quality standards, you will play a key role in mentoring clinicians, improving denial prevention strategies, and supporting client engagement initiatives. The environment is fully remote, mission-driven, and centered on innovation, operational excellence, and measurable impact.

• Lead and develop clinical appeals teams responsible for drafting and reviewing high-quality payer appeal communications.
• Oversee hiring, onboarding, coaching, performance management, and ongoing development of domestic and global clinical staff.
• Establish and maintain quality assurance programs to ensure clinical accuracy, consistency, compliance, and effectiveness of appeal letters.
• Monitor operational performance metrics, overturn rates, productivity standards, and workflow efficiency to support organizational goals.
• Collaborate with administrative operations and leadership teams to align staffing, case volumes, and financial objectives.
• Analyze denial trends, identify root causes, and provide actionable recommendations to improve documentation and reduce future denials.
• Serve as a clinical subject matter expert during client meetings, escalations, education sessions, and strategic initiatives.
• Drive continuous improvement efforts focused on operational scalability, workflow optimization, and service excellence.

• Active RN, MD, or DO license required; unrestricted medical license preferred.
• Minimum of 8 years of clinical experience, including at least 5 years in leadership roles related to appeals, utilization management, CDI, or revenue cycle management.
• Strong understanding of payer appeals processes, healthcare regulations, clinical documentation standards, and denial management.
• Proven experience leading high-volume clinical teams in fast-paced and matrixed environments.
• Demonstrated success building QA programs and improving operational workflows and clinical performance.
• Knowledge of DRG coding, CDI best practices, and payer denial trends is highly desirable.
• Experience working with both domestic and offshore/global teams preferred.
• Excellent leadership, communication, analytical, and stakeholder management skills.
• Ability to manage multiple priorities while maintaining high standards of clinical integrity and operational excellence.

• Fully remote work environment within the United States
• Competitive compensation package
• Opportunities for professional growth and leadership development
• Collaborative and mission-driven culture
• Exposure to innovative healthcare revenue cycle solutions and technologies
• Work with cross-functional teams and high-impact healthcare clients
• Occasional travel opportunities for client engagement and industry events
• Supportive environment focused on continuous learning and operational excellence.