Clinical Appeals Supervisor

Clinical Appeals Supervisor

Remote | Full-Time | $85,000-$100,000 per year

Work Remotely. Grow Professionally. Feel Valued.

For more than 30 years, Managed Resources, Inc. has partnered with healthcare organizations nationwide to improve performance, strengthen revenue cycle operations, support compliance, and help providers focus on delivering quality patient care.

We’re proud of the work we do, but we’re equally proud of the workplace we’ve built.

At Managed Resources, you’ll find the stability and reputation of an established healthcare consulting firm combined with the accessibility, collaboration, and growth opportunities of a smaller organization. Here, your contributions are visible, your ideas are welcomed, and your work makes a meaningful impact.

Compensation

Salary Range: $85,000-$100,000 per year

Actual compensation will be determined based on factors including experience, qualifications, specialized skills, geographic location, and internal equity considerations.

Quick Facts

• Remote
• Full-Time
• Competitive Compensation
• Phone & Internet Stipend
• Medical, Dental, and Vision Benefits (Full-Time Employees)
• 401(k) Retirement Plan with Company Match
• Paid Time Off, Seven Company Holidays, and Two Floating Holidays (Full-Time Employees)
• Professional Development Opportunities
• Employee Recognition Programs

Why Join Managed Resources?

Your Voice Matters

At Managed Resources, employee feedback isn’t collected and forgotten; it helps drive meaningful change.

Employee feedback has contributed to enhancements in employee recognition programs, professional development opportunities, communication initiatives, employee experience improvements, and technology investments. We believe the people closest to the work often have the best ideas.

Feeling Valued Matters

We believe great work deserves recognition.

Throughout the year, we celebrate employee contributions through appreciation initiatives, recognition programs, milestone celebrations, and professional observances such as Nurses Week and Coding Week. We intentionally create opportunities for employees to feel seen, valued, and appreciated.

A Remote Team That Stays Connected

Remote work shouldn’t mean feeling disconnected.

We foster connection through virtual team events, company celebrations, employee appreciation activities, holiday gatherings, and opportunities for collaboration across teams. Our employees enjoy the flexibility of remote work while remaining part of an engaged and supportive culture.

Opportunities to Learn and Grow

Whether you’re looking to deepen your expertise, expand your skill set, or take the next step in your career, Managed Resources supports continuous learning and professional growth.

Our leaders are accessible, collaborative, and invested in helping employees succeed.

The Best of Both Worlds

As an established organization with more than three decades of success, we offer stability, industry expertise, and long-standing client relationships.

As a smaller organization, employees have the opportunity to build meaningful relationships, gain visibility with leadership, contribute ideas, influence change, and make a measurable impact on the organization.

Your work matters here.

About the Opportunity

The Clinical Appeals Supervisor is responsible for direct oversight of the clinical appeals team ensuring high-quality appeal reviews are completed, and appeal letters are submitted timely. The Supervisor manages team schedules, monitors quality and productivity to ensure standards are met, and assists in the preparation of internal and external reports. The Supervisor provides day-to-day leadership, quality oversight, and staff development for the appeals team. This role requires strong medical necessity review experience, revenue cycle knowledge, organizational, communication, analytical skills, and sound clinical judgement to effectively guide staff.

Why This Role Matters

What You’ll Gain

• Flexibility of a remote work environment
• Visibility and access to leadership
• Opportunity to contribute ideas and influence change
• Professional development and career growth opportunities
• Meaningful work supporting healthcare organizations nationwide
• A collaborative culture that values employee success, recognition, and work-life balance

What You’ll Do

• Supervise the day-to-day operations of the clinical appeals team, including staff scheduling, workload assignments, and coverage planning.
• Provide direct supervision of staff, including participation in hiring, onboarding, coaching and performance management.
• Prepare and conduct annual employee performance evaluations in accordance with company guidelines and established HR processes.
• Review and approve employee timesheets in accordance with company timekeeping policies and procedures.
• Oversee the timely and accurate review, development, and submission of clinical appeals, ensuring established deadlines and payer requirements are consistently met.
• Review escalated or complex cases to determine appeal viability and provide guidance to staff on the appropriate clinical and regulatory approach.
• Escalate complex, high-risk, or potentially noncompliant cases to the Manager as appropriate.
• Monitor individual and team productivity, quality, and turnaround times against established benchmarks and performance expectations.
• Conduct regular audits and quality reviews of appeal cases, identify errors or delays, and provide feedback, coaching, and corrective action as needed.
• Monitor appeal inventory, outstanding cases, and submission deadlines to ensure timely completion and appropriate workload management.
• Analyze recurring denial trends and patterns, identify root causes and emerging risks, and provide management with actionable recommendations to improve appeal outcomes, reduce preventable denials, and support continuous process improvement.
• Monitor appeal outcomes, including upheld and overturned determinations, and analyze appeal success and overturn rates by payer, denial type, reviewer, service line, and other relevant categories.
• Evaluate payer responses and appeal outcomes to identify opportunities to improve appeal quality, accuracy, effectiveness, and overall team performance.
• Utilize denial and appeal data to identify coaching opportunities, training needs, workflow improvements, and denial prevention strategies; collaborate with the Manager to implement appropriate process improvements.
• Serve as a subject matter expert and resource for the Director, Manager, Team Leads, and Appeal Reviewers regarding clinical appeals, payer requirements, and related operational questions.
• Lead internal staff training and monthly team meetings as delegated by the Manager.
• Provide ongoing training, mentorship, and education to clinical appeals staff in collaboration with the Manager and Team Leads, supporting professional growth and competency development.
• Assist in preparing internal and external reports, performance summaries, training documents, and educational materials in collaboration with the Manager.
• Participate in client meetings, training sessions, and presentations as needed in partnership with the Manager.
• Maintain current knowledge of applicable regulatory changes, payer policies, coding guidelines, clinical review criteria, and screening standards, and ensure staff receive appropriate updates and education.
• Ensure team practices comply with organizational policies, applicable regulatory requirements, and HIPAA standards governing the access, use, and disclosure of protected health information.
• Perform other duties as assigned.

What You’ll Bring

• Current, active RN license (BSN preferred)
• 3-5 years of experience as a Supervisor of Clinical Appeals, Utilization Review, or similar position
• Credentialed in field of specialty (Case Management, Utilization Review, Legal Nurse) Preferred
• Minimum of five (5) years of experience in utilization review, clinical appeals
• Possess knowledge and experience with national clinical criteria applied in case management including InterQual and Milliman standards
• Working knowledge of billing codes, Revenue Codes, CPT’s, NCD/LCDs, etc
• Experience and knowledge of managed care contracts, account receivables and revenue cycle functions
• Working knowledge of provider billing guidelines, payer reimbursement policies, and related industry-based standards
• Knowledge of managed care denials and underpayment decisions
• 2-3 years of experience performing education/training
• Demonstrated leadership skills and abilities including team building, conflict resolution, project management and effective decision making
• Experience researching and deciphering payer policies and regulations

Benefits & Perks

Full-Time Employees

• Medical, Dental, and Vision Insurance
• Phone and Internet Stipend
• Company-Paid Life Insurance
• 401(k) Retirement Plan with Company Match
• Paid Time Off
• Seven Company-Observed Holidays
• Two Floating Holidays for Personal Observance
• Professional Development Opportunities
• Employee Recognition Programs
• Remote Work Environment

Ready to Join Us?

If you’re looking for a company where your expertise is respected, your contributions are recognized, and your work has a meaningful impact, we’d love to hear from you.

Join a team that combines the stability of an established healthcare consulting organization with the culture, connection, and growth opportunities of a smaller company.

Apply today and build your career with Managed Resources.

Managed Resources, Inc. is an Equal Opportunity Employer and is committed to creating an inclusive workplace where all employees can thrive.