Director, Clinical Denials Management (RN or MD/DO) (FT/REMOTE)

Responsibilities

• Build and scale the clinical letter writing team according to client demand
• Oversee the hiring, onboarding, and performance management of clinical writers
• Ensure quality, productivity, and team training programs meet standards
• Lead clinical review and maintain appeal content oversight
• Drive improvement across QA programs for clinical accuracy and appropriateness
• Align clinical operations with operational financial models and KPIs
• Identify process improvements to enhance team productivity and quality

Qualifications

• Active, unrestricted RN, MD, or DO license required; compact license preferred
• 8+ years of clinical experience with a minimum of 5 years in a leadership role related to appeals or RCM functions
• Mandatory experience with DRG downgrades
• Strong understanding of payer appeals processes and healthcare documentation standards
• Demonstrated success managing teams in high-volume, fast-paced settings

Benefits

• Medical, Dental, and Vision Insurance
• 401k matching program
• Unlimited Flex PTO
• Paid Paternity and Maternity leave programs
• Tuition reimbursement and additional benefits provided