Non-Clinical Careers at Lifespan

Manager - Clinical Appeals Job

Job Number: LCS18178

Job Title: Mgr Clinical Appeals

Department: Appeals Coordination - 0014682

Facility: Corporate Headquarters

Location: Providence, RI


The Appeals Manager reports to the Director of Claims Administration. Under general supervision and within Lifespan policies and procedures, manages and coordinates the appeal process for Lifespan. Assists and participates in the review and development of all levels of appeals. Develops and maintains current and accurate statistical data as it pertains to denied cases. Identifies and provides education on areas of documentation improvement with respect to level of care.

QUALIFICATIONS-EDUCATION:

Bachelor’s degree in nursing (BSN) required, Masters preferred with current licensure to practice as a registered nurse within the State of Rhode Island, or in another state that participates in the Nurse Licensure Compact.

QUALIFICATIONS-EXPERIENCE:

Five to seven years progressively more responsible clinical experience in an acute care setting, demonstrating advanced clinical expertise and extensive knowledge of complex disease processes.

Experience must demonstrate effective leadership, managerial and organizational skills, with highly developed oral and written communication skills to effectively direct staff and to discuss the denied case at all levels of the appeal process.

Working knowledge of activities associated with utilization review, case management and the appeal process and regulations.

Demonstrate knowledge and skills necessary to understand the care provided to patients throughout the life span, with consideration of aging processes, human development stages and cultural patterns in each step of the care process.

Proficient in computer usage, especially database and spreadsheet analysis.

Extensive knowledge of nursing care, clinical measurement tools, and clinical outcomes.

Knowledge of care delivery documentation systems and related medical record documents.

Highly effective interpersonal skills to establish cooperative working relationship with diverse groups and individuals, the medical staff, and other healthcare disciplines.