Role OverviewThe BPO Senior Manager leads and oversees a team of clinical reviewers supporting the appeals and utilization management process. This role ensures all appeal reviews are completed accurately, timely, and in compliance with state and federal regulations, NCQA standards, organizational policies, and customer requirements.
What You Will Do
The manager serves as a clinical subject matter expert, provides training and coaching, manages team performance, and drives continuous process improvement initiatives to enhance operational efficiency and quality outcomes.
Why It Might Be a Fit
This position requires a strong leader with experience in appeals management, utilization management, or clinical review operations, as well as expertise in reviewing medical records and clinical documentation.
Requirements
- 5 years of experience in appeals management, utilization management, or clinical review operations
- 1 year of leadership experience in a supervisory, managerial, or team lead role
- Experience managing teams in a healthcare, managed care, health plan, or utilization management environment
- Active Registered Nurse (RN) license required
- Florida State-required RN licensure and/or Compact State RN License required
Benefits
- Medical, dental, and vision insurance with an employer contribution
- Flexible spending or health savings account
- Life and AD&D insurance
- Short- and long-term disability coverage
- Paid time off
- Employee assistance
- Participation in a 401k program with company match
- Additional voluntary or legally required benefits
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