Operations Manager - PHRN

LOB Description

Medical Necessity Review for Appeals (Claims denied due to medical necessity)

Job Summary

The Operations Manager for Appeals is responsible for managing and overseeing operations related to clinical appeals, ensuring compliance with industry standards and regulatory requirements. The role involves close collaboration with various stakeholders to drive performance and maintain high-quality standards.

Key Responsibilities

Oversee daily operations and ensure compliance with SLAs and regulatory standards.

Develop and implement process improvement initiatives.

Manage team performance and resource allocation.

Collaborate with internal and client stakeholders to enhance service delivery and maintain accurate staffing.

Ensure adherence to HIPAA and other regulatory requirements.

Education & Certification

Bachelor's Degree in Nursing Graduate

PH Registered Nurse (Active License)

Minimum 1 year in a Manager role Work Experience Experience in managing teams handling Clinical Appeals