Director, Clinical Denials Management (RN or MD/DO) (FT/REMOTE)

 About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.  

JOB SUMMARY:

The Director of Clinician Appeals is a clinical leader responsible for the strategic oversight and operational execution of the appeals letter writing and client education engagement. This individual will lead high-performing clinical teams in the development of clinically accurate, persuasive, and compliant appeal communications to payers, while ensuring operational excellence, clinical integrity, and alignment with financial goals. This position works closely with internal leadership, administrative operations, and external clients to ensure best-in-class service delivery in a dynamic revenue cycle environment.

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

This is a REMOTE Position within the US Only. Permanent Work Status Req'd Position Title: Director, Clinician AppealsLocation: Remote within US OnlyTravel Requirements: Occasional travel to client sites, industry events, or internal team meetings at the NJ office.

The ideal candidate WILL HAVE an active, unrestricted RN license (compact preferred), will be a strong communicator who can confidently engage with hospital executives, physicians, and clients to explain medical scenarios, discuss denial trends, and provide clear education on documentation improvements. DRG Downgrade experience is highly preferred, and you must be able to analyze denial types, identify root causes, and deliver actionable feedback that helps prevent future denials.

You will play a major role in managing and developing both domestic and global clinicians who write appeal letters. This includes interviewing candidates, supporting onboarding and ramp‑up, serving as a subject‑matter expert, monitoring quality, and evaluating team performance (e.g., overturn rates, letter effectiveness). Experience working with offshore teams, a clinical background such as RN, coding expertise, or experience in CDI or DRG validation.

Key Responsibilities:

Clinical Letter Writing Team Leadership:

• Build, lead, and scale the clinical letter writing team, ensuring appropriate staffing levels aligned to current and forecasted client demand.

• Oversee hiring, onboarding, training, and performance management of clinical writers.

• Define and implement the team’s leadership structure and workflows.

• Enforce quality and productivity standards; take corrective action as needed to maintain high performance.

Team Oversight:

• Lead the team responsible for clinical review and oversight of appeal content.

• Finalize training programs and establish QA standards for

• Ensure appropriate staffing, leadership hierarchy, and performance accountability for

Quality Assurance & Clinical Integrity:

• Develop and continuously improve robust QA programs

• Ensure appeal content meets or exceeds clinical accuracy, appropriateness, and grammatical standards.

• Drive clinical consistency across all client deliverables.

Operational and Financial Alignment:

• Understand the appeals financial model and associated KPIs; align clinical operations to meet or exceed revenue and margin targets.

• Partner with administrative operations leadership to ensure seamless movement of cases through the appeals workflow.

• Maintain a proactive awareness of client demand changes and implementation timelines to ensure clinical team capacity aligns with needs.

Strategic Initiatives & Client Engagement:

• Identify and champion process improvement and efficiency initiatives to increase clinical team productivity without compromising quality.

• Participate in client meetings, Q&A sessions, and escalations to provide clinical insight and support resolution.

• Serve as a clinical subject matter expert for internal and external stakeholders.

Qualifications:

• RN, required; active, unrestricted medical license (any state) preferred.

• Minimum 8+ years of clinical experience with at least 5 years in a leadership role within appeals, utilization management, clinical documentation improvement (CDI), or similar RCM functions.

• DRG Downgrade experience is mandatory.

• Strong knowledge of payer appeals processes, healthcare regulations, and documentation standards.

• Demonstrated success in managing clinical teams in a high-volume, fast-paced environment.

• Proven experience developing QA programs and implementing clinical workflow improvements.

• Strong understanding of financial models and operational KPIs in the revenue cycle industry.

• Exceptional communication, collaboration, and leadership skills.

Preferred Qualifications:

• Previous experience in a revenue cycle management or health tech company.

• Knowledge of DRG coding, CDI best practices, and payer denial trends.

• Experience working with both domestic and global teams.

Working Conditions:

• Remote with occasional travel to client sites, industry events, or internal team meetings.

• Must be able to work in a matrixed, cross-functional environment

What we offer:

• Competitive annual salary

• Medical/Dental/Vision Insurance

• Equipment provided

• 401k matching program 

• FTO: Flex Unlimited Annual PTO

• Paid Paternity & Maternity leave programs

• 9 paid annual holidays

• Life Insurance

• Long term disability

• Short term disability options

• Tuition reimbursement

• and much more!

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.