Director Appeal Resolution

Professional & CorporateHybrid Remote, Danbury, Connecticut


Description

Position at Nuvance Health

 

Northwell is the largest not-for-profit health system in the Northeast, serving residents of New York and Connecticut with 28 hospitals, more than 1,000 outpatient facilities, 22,000 nurses and over 20,000 physicians. Northwell cares for more than three million people annually in the New York metro area, including Long Island, the Hudson Valley, Connecticut and beyond, thanks to philanthropic support from our communities. Northwell is New York State’s largest private employer with over 104,000 employees — including members of Northwell Health Physician Partners — who are working to change health care for the better. 

 

Summary: 

Directs, plans, and organizes the staff and activities related to denials and appeals for the organization. Functions as the health system's resource and liaison between commercial payers, managed care and third-party review organizations in managing the appeals/denials process. Reports on operational performance, justification and/or corrective action to management.

 

Responsibilities: 

  • Leads the Appeal Resolution group by communicating with and developing staff members, and building consensus for programs and goals that support a business, function or geographic area.
  • Develops and articulates a short-term strategic vision for areas of responsibility.
  • Directs, plans, and organizes the staff and activities related to clinical reviews, denials and appeals for the organization.
  • Functions as the health system's resource and liaison between commercial payers, managed care and third party review organizations in managing the clinical reviews, appeals and denials process.
  • Reports on operational performance, justification and/or corrective action to management.
  • Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act.
  • Duties not mentioned here, but considered related are not essential functions.

 

 

Education Skills Experience: 

 

  • Bachelor of Science in Nursing required.
  • Current License to practice as a Registered Professional Nurse in New York  State required, plus specialized certifications as needed.
  • 8-12 years of relevant experience and 7+ years of leadership / management experience, required.

 

 

Company: Nuvance Health

Org Unit: 2092

Department: Care Coordination

Exempt: Yes

Salary Range: $59.84 - $111.12 Hourly

 

 

“Available benefits include: Paid Time Off (PTO); Medical, Dental and Vision Coverage; Health and Dependent Care Flexible Spending Accounts; Health Savings Account; 401(k) Retirement Plan; Basic Life and AD&D insurance; Wellness Programs; Employee Assistance Program; and Team Member Discounts. Available benefits for union positions may vary in accordance with applicable Collective Bargaining Agreements.”

Disclaimer

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