Manager, Appeals Management

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Manager, Appeals Management based in United States.

This leadership role oversees the strategy, quality, and execution of clinical appeals operations within a fast-paced healthcare environment. The position is responsible for managing clinical teams, improving workflows, and ensuring accurate, persuasive, and compliant appeal communications. The successful candidate will combine clinical expertise with operational leadership to improve payer outcomes and support financial performance. This role requires collaboration with healthcare stakeholders, internal teams, and clients to drive service excellence. The ideal professional will have experience leading clinical teams, optimizing quality programs, and delivering measurable improvements. Working remotely, this position offers the opportunity to influence healthcare revenue cycle processes while developing high-performing teams.

Accountabilities:: The Manager, Appeals Management will provide strategic and operational leadership for clinical appeals activities, ensuring high-quality deliverables, team performance, and alignment with client objectives. This role will lead clinical writing teams, strengthen quality standards, improve processes, and act as a subject matter expert for internal and external stakeholders.

Build, lead, and scale clinical appeal writing teams to support current and future client requirements.

Oversee recruitment, onboarding, training, coaching, and performance management of clinical team members.

Establish team structures, workflows, productivity expectations, and accountability standards.

Manage clinical review and oversight processes to ensure appeal communications are accurate, compliant, and effective.

Develop and enhance quality assurance programs to maintain clinical integrity, consistency, and documentation excellence.

Monitor team performance metrics, including quality indicators, productivity measures, and appeal effectiveness outcomes.

Align clinical operations with financial objectives, revenue targets, and key performance indicators.

Partner with operational leadership to optimize case workflows and ensure timely delivery of client commitments.

Analyze denial trends, identify root causes, and provide actionable recommendations to improve future outcomes.

Participate in client meetings, escalations, and educational sessions by providing clinical expertise and strategic guidance.

Drive continuous improvement initiatives that increase efficiency while maintaining high service standards.

Support collaboration across domestic and international teams within a matrixed environment.

Requirements:

The ideal candidate is an experienced clinical leader with a strong background in healthcare appeals, utilization management, clinical documentation improvement, or related revenue cycle operations. They should combine deep clinical knowledge with proven leadership capabilities and the ability to manage complex teams and client relationships.

Active, unrestricted RN license required; compact license preferred.

Minimum of 8 years of clinical experience, including at least 5 years in a leadership role within appeals, utilization management, CDI, or similar healthcare functions.

Mandatory experience with DRG downgrade reviews and appeals.

Strong understanding of payer appeals processes, healthcare regulations, documentation requirements, and denial management strategies.

Proven experience managing high-performing clinical teams in a fast-paced operational environment.

Experience developing quality assurance programs and improving clinical workflows.

Knowledge of DRG coding, CDI practices, and payer denial trends preferred.

Experience working with domestic and global teams is highly valued.

Strong understanding of operational metrics, financial models, and revenue cycle performance indicators.

Excellent communication, leadership, collaboration, and stakeholder management skills.

Ability to work effectively in a remote, cross-functional, and constantly evolving environment.

Willingness to travel occasionally for client meetings, industry events, or internal team gatherings.

Benefits:

Competitive annual salary package.

Medical, dental, and vision insurance coverage.

Company-provided equipment for remote work.

401(k) matching program.

Flexible unlimited paid time off program.

Paid maternity and paternity leave.

Paid annual holidays.

Life insurance coverage.

Short-term and long-term disability benefits.

Tuition reimbursement opportunities.

Remote work flexibility with occasional travel opportunities.

Career growth and professional development support.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!  Why Apply Through Jobgether?    Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.     #LI-CL1