**Req Number** 179629 Job Description Supervises and oversees the operations of the centralized appeals and denial prevention process for the organization. Performs quality audits on clinical reviews and appeal letters. Facilitates the even work-flow to maintain timely response to clinical review and appeals. Job Responsibility + Promotes Appeal Resolution department goals by selecting, motivating, and training capable team members. + Leads the activities of assigned Appeal Resolution team members by communicating and providing guidance toward achieving department objectives. + Supervises, hires, trains, disciplines, and evaluates the performance of staff; ensures performance appraisals on inpatient auditors are completed in a timely manner. + Provides training to new employees; performs monthly quality reviews on staff; identifies, evaluates, and implements opportunities for efficiencies. + Plans, organizes, coordinates, and evaluates staffing requirements to meet operational goals; assigns and schedules direct reports to ensure smooth and efficient workflow. + Promotes staff development and education by providing opportunities for formal and informal education to promote competency; develops and performs staff educational programs; ensures staff completes annual training. + Maintains data tracking systems and provides reports to staff; sets performance standards and provides ongoing feedback to staff. + Generates department metrics; reports operational performance, justification, and/or corrective action. + Oversees and coordinates appeals process. + Reviews and evaluates cases denied by all Third Party payers and determines follow through for level of appeals; assigns cases to staff, as appropriate. + Monitors inpatient denials and assists patients and physicians with management of the appeals process. + 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. Job Qualification + Graduate from an accredited School of Nursing required. + Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications as needed. + 4-6 years of relevant experience and 0-2 years of leadership / management experience, required. + **BSN** **from an accredited school of nursing.** **Preferred** ***Additional Salary Detail** The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future.When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity). The salary range for this position is $91400-$158100/year It is Northwell Health’s policy to provide equal employment opportunity and treat all applicants and employees equally regardless of their age, race, creed/religion, color, national origin, immigration status or citizenship status, sexual orientation, military or veteran status, sex/gender, gender identity, gender expression, disability, pregnancy, genetic information or genetic predisposition or carrier status, marital or familial status, partnership status, victim of domestic violence, sexual or other reproductive health decisions, or other characteristics protected by applicable law.