Manager, Appeals Management

 About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.  

JOB SUMMARY:

The Manager of Clinician Appeals is a clinical leader responsible for the strategic oversight and operational execution of the appeals letter writing and client education engagement. This individual will lead high-performing clinical teams in the development of clinically accurate, persuasive, and compliant appeal communications to payers, while ensuring operational excellence, clinical integrity, and alignment with financial goals. This position works closely with internal leadership, administrative operations, and external clients to ensure best-in-class service delivery in a dynamic revenue cycle environment.

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

This is a REMOTE Position within the US Only.

Position Title: Manager, Clinician Appeals

Location: Remote within US Only

Travel Requirements: Occasional travel to client sites, industry events, or internal team meetings at the NJ office.

The ideal candidate WILL HAVE an active, unrestricted RN license (compact preferred), will be a strong communicator who can confidently engage with hospital executives, physicians, and clients to explain medical scenarios, discuss denial trends, and provide clear education on documentation improvements. DRG Downgrade experience is highly preferred, and you must be able to analyze denial types, identify root causes, and deliver actionable feedback that helps prevent future denials.

You will play a major role in managing and developing both domestic and global clinicians who write appeal letters. This includes interviewing candidates, supporting onboarding and ramp‑up, serving as a subject‑matter expert, monitoring quality, and evaluating team performance (e.g., overturn rates, letter effectiveness). Experience working with offshore teams, a clinical background such as RN, coding expertise, or experience in CDI or DRG validation.

Key Responsibilities:

Clinical Letter Writing Team Leadership:

• Build, lead, and scale the clinical letter writing team, ensuring appropriate staffing levels aligned to current and forecasted client demand.

• Oversee hiring, onboarding, training, and performance management of clinical writers.

• Define and implement the team’s leadership structure and workflows.

• Enforce quality and productivity standards; take corrective action as needed to maintain high performance.

Team Oversight:

• Lead the team responsible for clinical review and oversight of appeal content.

• Finalize training programs and establish QA standards for

• Ensure appropriate staffing, leadership hierarchy, and performance accountability for

Quality Assurance & Clinical Integrity:

• Develop and continuously improve robust QA programs

• Ensure appeal content meets or exceeds clinical accuracy, appropriateness, and grammatical standards.

• Drive clinical consistency across all client deliverables.

Operational and Financial Alignment:

• Understand the appeals financial model and associated KPIs; align clinical operations to meet or exceed revenue and margin targets.

• Partner with administrative operations leadership to ensure seamless movement of cases through the appeals workflow.

• Maintain a proactive awareness of client demand changes and implementation timelines to ensure clinical team capacity aligns with needs.

Strategic Initiatives & Client Engagement:

• Identify and champion process improvement and efficiency initiatives to increase clinical team productivity without compromising quali