Manager, Medical Review (Medicare - Appeals; Utilization Review; Part A; HHH)

# # # To learn more about our website privacy policy, click on this .**Location:** This is a full-time position (40 hours per week), Monday through Friday, based in a collaborative office environment during standard business hours of 8:00 AM to 5:00 PM. The primary work location is 26 Century Blvd., Suite ST610, Nashville, TN 37214. Depending on business needs and individual circumstances, **remote or hybrid work arrangements may be available** for qualified and interested candidates.* **Required Work Experience:** 5 years clinical and utilization review to include 2 years supervisory or team lead experience or equivalent military experience in grade E4 or above.* **Required Skills and Abilities:** Excellent verbal and written communication, organizational, customer service, analytical or critical thinking, and presentation skills. Good judgment skills. Proficient spelling, grammar, punctuation, and basic business math. Ability to persuade, negotiate or influence, and handle confidential or sensitive information with discretion. Knowledge of government programs and guidelines, medical and legal terminology, and disease management and litigation processes.* **Required Software and Tools:** Microsoft Office.* **Required Licenses and Certificates:** Active RN licensure in state hired, OR, active compact multistate RN license as defined by the Nurse Licensure Compact (NLC).**Required Education:** Bachelor's degree in a job-related field.* Demonstrated expertise in Medicare claim reviews (Appeals, Utilization Review, Part B, HHH), and a thorough understanding of Medicare policies/coverages/regulations.* Demonstrated experience leading teams of 15–20 professionals across clinical and non-clinical functions, with a consistent focus on maintaining high-quality standards.* Strong commitment to continuous process improvement and operational efficiency.* Proven experience managing.* Subsidized health plans, dental and vision coverage* 401k retirement savings plan with company match* Life Insurance* Paid Time Off (PTO)* On-site cafeterias and fitness centers in major locations* Education Assistance* Service Recognition* National discounts to movies, theaters, zoos, theme parks and more
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