Registered Nurse ( RN ) Appeals Manager

5 - 7 years experience  •  Misc. Healthcare

Salary depends on experience
Posted on 11/02/17
5 - 7 years experience
Misc. Healthcare
Salary depends on experience
Posted on 11/02/17

Career ID 2017-3720

Overview

The Manager of Appeals is responsible to oversee and manage all aspects of the Appeals Department including compliance, reporting, scheduling, prioritizing, coaching, policy and procedures, monitoring department key performance metrics and providing support to Team Leaders, Appeal Nurse Reviewers and Appeal Coordinators. This requires practical knowledge in leading and managing the execution of processes, projects and tactics within the appeals area. Will provide primary input to hiring, firing, promotion, and performance and rewards decisions for direct reports. Also, explains policies, practices, and procedures of the appeals area to others within the organization and externally. May work to justify and gain cooperation of other parties on appeal practices, policies, and procedures.

Responsibilities

 

  • Recommended 5-7 years previous supervisory or managed care experience with knowledge of industry regulatory requirements.
  • University degree or equivalent experience.
  • Maintains an active license as a Registered Nurse (RN) without restriction
  • Must be in good standing with the Company
  • Working knowledge of business systems and methods used for data collection, root cause analysis and performance measurement
  • Demonstrated advanced proficiency in MS Office applications
  • Knowledge and experience in the appeal arena for commercial, Medicaid and Medicare lines of business including regulatory compliance requirements preferred
  • Experience in a health services, or managed care operations environment preferred

Qualifications

Knowledge:

  • Excellent problem solving, analytical and customer service skill
  • Strong oral and written communication skills
  • Sound problem resolution, judgment, team building and decision making skills
  • Analytical ability to identify problems, develop solutions and implement an effective course of action
  • Ability to work effectively and productively with varied levels of personnel, with professionals and business organizations
  • Strong personal computing skills

Special Skills and Requirements:

  • Outstanding presentation, verbal and communication skills
  • Demonstrates professionalism, accountability, and integrity
  • Self-directed, highly motivated
  • Detail oriented
  • Ability to relate well to all types of people
  • Ability to listen actively and responsively
  • Minimal travelrequired
  • Adheres to all evicore protocols, policies and procedures
  • Performs other duties as assigned
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