Director of Clinical Denials Management (RN)

New York Metro Area, NY

Department: Nurse Job Number: 5172

Title: Senior Director of Clinical Denials Management (RN)

Location: New York Metro Area

Industry: Healthcare

Occupational Category: Nurse

Hours: Full-time

Description: Hiring a Senior Director of Clinical Denials Management for a leading academic medical center in New York Metro Are. The Senior Director of Clinical Denials Management provides strategic vision and direction for the Clinical Denials Management program.   


  • Leads process improvement initiatives to prevent denials.
  • Facilitate monthly denial meetings and communicate denial trends to Leadership, Case Management, and Physician Advisors.
  • Monitor and track clinical denials and appeals workflow to ensure timely submission of required appeals.
  • Evaluate potentially avoidable utilization trends within departments.
  • Recruit, on-board, train, and evaluate employees.
  • Develop and maintain productivity standards for areas of direct responsibility and monitors adherence to those standards.

 Education Requirements:

  • RN with bachelor's degree required; Master's degree strongly preferred.

 Experience Requirements:

  • 3 to 5 years of progressive experience in appeal/denial management
  • 3 to 5 years management experience
  • 3 to 5 years of progressive experience with utilization management or care management

 Desired Skills: 

  • Strong knowledge of health plan requirements 
  • Knowledge of EPIC enterprise system preferred. 
  • Knowledge of coding guidelines, both ICD-10 and CPT is preferred.  
  • CCS Preferred.
  • Knowledge of federal, regional and state payer coverage patterns (CMS, fiscal intermediary, and Administrative Law Judge).
  • Excellent communication and interpersonal skills. 
  • Strong analytical and statistical analysis skills required
  • Microsoft Excel, Word and PowerPoint skills required.
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