OUR CULTURAL BELIEFS
Patient Minded I act with the patient’s best interest in mind.
Client Delight I own every client experience and its impact on results.
Take Action I am empowered and empower others to act now.
Grow Talent I own my development and invest in the development of others.
Win Together I passionately connect with anyone, anywhere, anytime to achieve results.
Communication Matters I speak up to create transparent, thoughtful and timely dialogue.
Own It I hold myself and others accountable for results.
The Medical Necessity Appeals Manager will serve as the subject matter expert for the medical necessity appeals process and is responsible for guiding and overseeing the Clinical Appeals Nurses and Clinical Navigation Resource Coordinator to ensure the highest quality Medical Necessity Appeals services to the patients of the clients we serve. The Medical Necessity Appeals Manager will collaborate to develop appropriate best practices and quality initiatives that include data collection, trending, analysis and reporting to ensure ongoing process improvements and client delight, and to ensure that all appeals efforts are carried out in a compliant manner with state and federal guidelines.
Our people leaders are tasked with delivering excellent business results through the efforts of their teams. These results are achieved by:
People leaders must possess both the skills to effectively accomplish these tasks and the emotional intelligence to do so in alignment with our cultural values. In addition to the critical management and leadership tasks listed above, this role also includes the following unique responsibilities:
essential duties and responsibilites:
The above list reflects the general details necessary to describe the principle and essential functions of the position and shall not be construed as the only duties that may be assigned for the position.
An individual in this position must be able to successfully perform the essential duties and responsibilities listed above. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.
The requirements listed below are representative of the experience, education, knowledge, skill and/or abilities required.
PHYSICAL AND MENTAL DEMANDS:
This is a largely sedentary role. While performing the duties of this job, the employee is regularly required to talk, hear, type and engage in repetitive motion.
The employee frequently is required to walk; use hands to finger, handle or feel; and reach with hands and arms. The employee is occasionally required to stand or grasp. The employee is intermittently required to stoop or crouch; push or pull; or kneel.
The employee must occasionally lift and/or move up to 10 pounds and intermittently lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
This role requires mental alertness. The employee must regularly communicate both verbally and written; concentrate on tasks; and remember and observe details. The employee must frequently adjust to changes; handle stress and emotions; and think analytically.
The mental and physical requirements described here are representative of those that must be met by an individual to successfully perform the essential functions of this position.
This job operates in a professional office environment. This role routinely uses standard office equipment. The noise level in the work environment is usually moderate. The employee is not substantially exposed to environmental conditions.
The work environment characteristics described here are representative of those an individual encounters while performing the essential functions of this position.