Manager, Clinician Appeals (Active RN License REQ'D)

CorroHealth•FL-Remote, FL

4d•Remote

About The Position

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. CorroHealth sits at the center of the revenue cycle revolution. Fundamental operations of the revenue cycle are supported through our expert teams while we recast the role of clinicians through automation. This shift to a true clinical revenue cycle helps us achieve our core purpose – exceed client financial health goals. For each patient population, CorroHealth automates key clinical aspects of the cycle. Our platforms focus on capture and application of clinical documentation while easing the burden on physicians. Scalability is prioritized in the support of client program operations. As with most revenue cycle partners, our skilled and enthusiastic team is available to outsource any portion of the cycle. However, we can also complement client programs with additional expert support or upskill existing client teams to meet program demands. Whether our team is deployed directly, or automation is incorporated for a more programmatic solution, CorroHealth delivers. CorroHealth has acquired Xtend Healthcare! For more information, please visit https://corrohealth.com. Applicants will only receive job-related emails from the domain @corrohealth.com. Additionally, it is important to emphasize that CorroHealth will never ask for money in return for a job offer.

Requirements

Active, unrestricted RN license (compact preferred)
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
Ability to analyze denial types, identify root causes, and deliver actionable feedback that helps prevent future denials.
Experience managing and developing both domestic and global clinicians who write appeal letters.
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).
RN, MD or DO license required; active, unrestricted medical license (any state) preferred.
Minimum 8+ years of clinical experience with at least 5 years in a leadership role within appeals, utilization management, clinical documentation improvement (CDI), or similar RCM functions.
DRG Downgrade experience is mandatory.
Strong knowledge of payer appeals processes, healthcare regulations, and documentation standards.
Demonstrated success in managing clinical teams in a high-volume, fast-paced environment.
Proven experience developing QA programs and implementing clinical workflow improvements.
Strong understanding of financial models and operational KPIs in the revenue cycle industry.
Exceptional communication, collaboration, and leadership skills.

Nice To Haves

Experience working with offshore teams
Clinical background such as RN, coding expertise, or experience in CDI or DRG validation.
Previous experience in a revenue cycle management or health tech company.
Knowledge of DRG coding, CDI best practices, and payer denial trends.
Experience working with both domestic and global teams.

Responsibilities

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.
Lead the team responsible for clinical review and oversight of appeal content.
Finalize training programs and establish QA standards.
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.
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.
Identify and champion process improvement and efficiency initiatives to increase clinical team productivity without compromising quality.
Participate in client meetings, Q&A sessions, and escalations to provide clinical insight and support resolution.
Serve as a clinical subject matter expert for internal and external stakeholders.