Manager Appeals and Grievances / Clinical Review

Job ID: 259816    Posted 7/15/2024

LOCATION

Location: New York, New York

JOB TYPE

Job Type: Direct Hire

CATEGORY

Category: Case Management

POSITION

Position: 259816

SKILLS

Skills:

SALARY

Salary Low: $115000 - Salary High: $140000

DURATION

Duration: 2 Weeks

SHIFT

Shift:

Job Description

Manager, A&G Clinical Review – Hybrid
Salary
: $115k – $140k
Location: Manhattan, NY

Responsibilities: 

  • Responsible for direct oversight and management of clinical review processes within Appeals & Grievances Department.
  • Ensures regulatory compliance and timely processing for the Medicare and Medicaid appeal and grievance processes, quality of care concerns and any other inquires requiring clinical review for medical necessity, appropriateness of service or clinical quality.
  • Acts as subject matter expert to internal departments and delegated vendors to assure all are educated and complaint with requirements of appeals and grievance regulations and processing

Qualifications:

  • Bachelor’s Degree required. Master’s preferred
  • 5 plus years’ experience in managed care including appeals and grievance and/or compliance
  • 2 years’ prior supervisory or management experience required
  • Strong knowledge of federal, state and managed healthcare regulations and requirements
  • NYS RN License Degree. Strong leadership skills

#LI-Hybrid

I want more jobs like this in my inbox.

Share This Job

Related Jobs

Job-Details- Why Us Image

Why Us?

At RCM Health Care Services, we redefine healthcare staffing, creating an environment where your career thrives and flourishes. Our commitment to your success is woven into the fabric of our culture, offering diverse opportunities for both seasoned professionals seeking challenges and newcomers ready to make their mark. As a part of the RCM family, you'll experience more than just a job – you'll find a platform for continuous growth and fulfillment.

We have cultivated an ecosystem where healthcare professionals not only find rewarding career opportunities but also a community that values their skills and dedication. Your success is our priority, and our collaborative environment ensures you're never alone on your professional journey. Competitive salaries and comprehensive benefits reflect our dedication to your well-being, allowing you to focus on what matters most – delivering exceptional care. Join RCM Health Care Services, a trusted partner with a proven track record since 1975 and embark on a journey where your path to a fulfilling healthcare career truly begins.

About Us

With a legacy spanning over 45 years, RCM Health Care Services is a leader in connecting healthcare professionals with rewarding career opportunities. Our foundation is built on cultivating relationships with school districts, setting the stage for our expansion into placing providers across diverse facility types. As we evolved, our expertise diversified across various divisions including School Services, Behavioral Health/ABA, Travel, Nursing, Therapy, HIM, Permanent Placement, Foreign Recruitment, Locums Tenens, and much more.
Our mission is clear: to elevate healthcare standards by empowering talented healthcare professionals and forming strategic partnerships with top-tier healthcare institutions and schools across the country. We proudly hold the Joint Commission Gold Seal of Approval, showcasing our commitment to the highest standards in healthcare.
Our commitment goes beyond filling positions; we actively build careers, foster growth, and make a profound difference in the lives of both our candidates and the patients they serve.