Director Appeal Resolution

Description

Northwellis the largest not-for-profit health system in the Northeast, serving residents of New York and Connecticut with 28 hospitals, more than 1,000 outpatient facilities, 22,000 nurses and over 20,000 physicians. Northwell cares for more than three million people annually in the New York metro area, including Long Island, the Hudson Valley, Connecticut and beyond, thanks to philanthropic support from our communities. Northwell is New York State’s largest private employer with over 104,000 employees — including members ofNorthwell Health Physician Partners— who are working to change health care for the better.

Summary:

Directs, plans, and organizes the staff and activities related to denials and appeals for the organization. Functions as the health system's resource and liaison between commercial payers, managed care and third-party review organizations in managing the appeals/denials process. Reports on operational performance, justification and/or corrective action to management.

Responsibilities:

• Leads the Appeal Resolution group by communicating with and developing staff members, and building consensus for programs and goals that support a business, function or geographic area.

• Develops and articulates a short-term strategic vision for areas of responsibility.

• Directs, plans, and organizes the staff and activities related to clinical reviews, denials and appeals for the organization.

• Functions as the health system's resource and liaison between commercial payers, managed care and third party review organizations in managing the clinical reviews, appeals and denials process.

• Reports on operational performance, justification and/or corrective action to management.

• Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act.

• Duties not mentioned here, but considered related are not essential functions.

Education Skills Experience:

• Bachelor of Science in Nursing required.

• Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications as needed.

• 8-12 years of relevant experience and 7+ years of leadership / management experience, required.

Company: Nuvance Health

Org Unit: 2092

Department: Care Coordination

Exempt: Yes

Salary Range: $59.84 - $111.12 Hourly

“Available benefits include: Paid Time Off (PTO); Medical, Dental and Vision Coverage; Health and Dependent Care Flexible Spending Accounts; Health Savings Account; 401(k) Retirement Plan; Basic Life and AD&D insurance; Wellness Programs; Employee Assistance Program; and Team Member Discounts. Available benefits for union positions may vary in accordance with applicable Collective Bargaining Agreements.”

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

It is Northwell Health’s policy to provide equal employment opportunity and treat all applicants and employees equally regardless of age, race, creed/religion, color, national origin, immigration status, or citizenship status, military or veteran status, sexual orientation, sex/gender, gender identity, gender expression, height, weight, disability, pregnancy, genetic information or genetic predisposition or carrier status, marital or familial status, partnership status, victim of domestic violence, their or their dependent’s sexual or other reproductive health decisions, or other characteristics protected by applicable law.