Supervisor, Appeals

About This Opportunity

We are representing a confidential healthcare organization in Canada seeking a Supervisor, Appeals to lead their clinical review operations. Our client operates in the managed care sector and requires strong leadership to oversee utilization management activities and ensure quality member care.

This is a supervisory position overseeing Prior Authorization, Concurrent Review, and Retrospective Review teams. You'll ensure compliance with regulatory standards while driving process improvements and supporting your team's professional development.

Responsibilities

• Supervise day-to-day operations of the utilization management clinical review team
• Monitor and track UM resources to ensure adherence to performance, compliance, quality, and efficiency standards
• Collaborate with the team to resolve complex member care issues
• Maintain current knowledge of regulations, accreditation standards, and industry best practices in utilization management
• Work with senior management to identify and implement process and quality improvement opportunities
• Ensure compliance with applicable guidelines, policies, and procedures for clinical reviews
• Develop and implement UM policies and procedures in partnership with senior leadership
• Evaluate team performance and provide coaching, feedback, and guidance on goals and career development
• Assist with onboarding, hiring, and training new team members
• Educate team on key initiatives and facilitate ongoing communication between staff, members, and providers
• Lead change management initiatives within your area of responsibility

What We're Looking For

• Graduate of an accredited nursing school or Bachelor's degree required
• 4+ years of related healthcare experience required
• 3-5 years of direct experience with appeals processes and utilization management principles in managed care/MCO environments strongly preferred
• Current and active RN (Registered Nurse) license required - California RN license strongly preferred for remote candidates
• Strong knowledge of appeals and utilization management principles
• Proven supervisory and leadership capabilities
• Excellent communication and coaching skills
• Ability to interpret and apply regulatory requirements and clinical guidelines
• Strong problem-solving and decision-making abilities

Important licensing note: Candidates must be willing to obtain an RN license for the state of California if not already held. Background check and RN license approval are required prior to starting.

How We Work With You

When you apply through Get A Job.ai, our recruiting team will review your qualifications and conduct an initial screening. If there's a strong match, we will prepare and submit your profile to our client for consideration. Please do not contact the employer directly - all communication regarding this opportunity should go through our team to ensure a coordinated and professional process.

Pay

Pay details will be discussed during the screening process with our recruiting team.

Equal Opportunity: Get A Job.ai is committed to diversity and inclusion in our recruiting practices. We welcome qualified candidates from all backgrounds and ensure fair consideration throughout our process.