Manager, Clinician Appeals

About the Company

The organization focuses on helping healthcare clients improve financial outcomes across the reimbursement cycle. It combines clinical expertise, scalable processes, and analytics-driven technology to support program needs and stay accountable to measurable results. The company also emphasizes long-term growth by investing in employee development and creating an environment that supports both professional and personal advancement.

Role Overview

The Manager of Clinician Appeals is a clinical leadership role responsible for both the strategy and day-to-day execution of appeal letter creation and client education activities. The position leads clinical teams that produce accurate, persuasive, and compliant appeal communications for payers, while maintaining strong clinical standards, efficient operations, and alignment with business goals. The role partners with internal leaders, administrative operations, and external clients to deliver high-quality service in a fast-moving revenue cycle setting.

Location and Travel

This is a remote role for candidates located in the United States only. The role includes occasional travel to client locations, industry events, or internal meetings at the New Jersey office.

Core Responsibilities

The successful candidate will oversee hiring, onboarding, training, staffing, workflow design, quality control, performance management, and client-facing clinical support for the appeal writing team. The role also involves analyzing denial trends, strengthening documentation education, improving processes, and ensuring clinical work aligns with operational and financial targets.

Required Background

Candidates must hold an active RN license, and an unrestricted medical license from any state is preferred. A strong clinical background is essential, along with deep experience in appeals, utilization management, CDI, or related revenue cycle functions. DRG downgrade experience is mandatory. The role also calls for strong communication skills, leadership ability, and comfort engaging with executives, physicians, and clients.

Preferred Experience

Experience with revenue cycle management or health technology companies is preferred. Familiarity with DRG coding, CDI best practices, denial patterns, and collaboration with domestic and global teams will be an advantage.

Working Conditions

The position is remote with periodic travel. It requires effective performance in a matrixed, cross-functional environment.

Compensation and Benefits

The role offers a competitive annual salary along with a broad benefits package. Benefits include medical, dental, and vision coverage; provided equipment; 401(k) matching; unlimited flexible paid time off; paid maternity and paternity leave; 9 paid holidays; life insurance; long-term disability; short-term disability options; tuition reimbursement; and additional company benefits.

Physical Requirements

The job requires regular eye-hand coordination and manual dexterity for office equipment use. The employee must be able to work at a computer for 6 to 8 hours per day, tolerate frequent interruptions, and remain seated for extended periods. Occasionally, the role may require lifting or moving materials weighing up to 20 lbs. Work may also involve elevated stress during busy periods and when managing multiple deadlines.

Additional Notes

This job description is intended as a general guide rather than a complete list of duties. Additional functions, tasks, skills, or requirements may be assigned by management as needed.