Director of Appeals
Virtual Vocations Inc, New York, NY, United States
A company is looking for a Director of Appeals to lead and manage the clinical appeals function within the Utilization Management department.
Key Responsibilities
Develop and implement strategic plans for the clinical appeals program Lead a team in managing appeals and grievances, ensuring compliance with regulatory standards Oversee the end-to-end appeals process and monitor performance metrics for continuous improvement
Required Qualifications
Professional designation as RN, NP, or CEBS preferred Minimum 7 years of healthcare experience, with at least 3 years in utilization management or appeals Strong knowledge of InterQual and payer policies Proven leadership experience in a healthcare setting Experience with electronic medical record systems and utilization management platforms preferred
Develop and implement strategic plans for the clinical appeals program Lead a team in managing appeals and grievances, ensuring compliance with regulatory standards Oversee the end-to-end appeals process and monitor performance metrics for continuous improvement
Required Qualifications
Professional designation as RN, NP, or CEBS preferred Minimum 7 years of healthcare experience, with at least 3 years in utilization management or appeals Strong knowledge of InterQual and payer policies Proven leadership experience in a healthcare setting Experience with electronic medical record systems and utilization management platforms preferred