New York State Licensed Appeals Manager

A company is looking for a Manager - Appeals to manage teams and oversee case management in a remote setting. Key Responsibilities Manage assigned teams and staff while ensuring compliance with quality control procedures Conduct medical necessity reviews and ensure compliance with state-specific regulations Collaborate with stakeholders to manage cases effectively and maintain accurate documentation Required Qualifications and Education Bachelor's degree in a relevant field and 5+ years of professional experience, or equivalent combination of education and experience Familiarity with Appeals & Hearings; expertise in the Hearings & Appeals function preferred Registered Nurse (RN) with a valid nursing license, or a Master's degree or JD Knowledge of workers' compensation laws and experience with New York State guidelines preferred Proficiency in claims management software and medical management practices

Apr 8, 2025 - 18:44

A company is looking for a Manager - Appeals to manage teams and oversee case management in a remote setting. Key Responsibilities Manage assigned teams and staff while ensuring compliance with quality control procedures Conduct medical necessity reviews and ensure compliance with state-specific regulations Collaborate with stakeholders to manage cases effectively and maintain accurate documentation Required Qualifications and Education Bachelor's degree in a relevant field and 5+ years of professional experience, or equivalent combination of education and experience Familiarity with Appeals & Hearings; expertise in the Hearings & Appeals function preferred Registered Nurse (RN) with a valid nursing license, or a Master's degree or JD Knowledge of workers' compensation laws and experience with New York State guidelines preferred Proficiency in claims management software and medical management practices