Clinical Appeals Manager (Hybrid)

This role manages the appeal process for members and providers who appeal on behalf of members for government program lines of business. Ensures quality management of the clinical appeal process to reduce the risk of State and Federal Regulatory fines and sanctions, avoid adverse exposure, reiterate the expectation of a fair and compliant appeal process for our membership, and support NCQA accreditation and the Divisional Goals for Health Services. Ideal candidate will have minimum of three yea…