Appeals Clinician, Denials Management (IC)

About the role

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member's performance objectives as outlined by the Team Member's immediate Leadership Team Member. Clinical Authorization Nurse / MBBS (Infusion & Surgery) Role Type: Full-time, RN/MBBS/Clinical Resource Position Overview We are seeking a Clinical Authorization Nurse (RN / MBBS) to support infusion and surgical services authorization processes. This role ensures that all required clinical documentation is reviewed, prepared, and submitted to payers for timely approval of scheduled services. The ideal candidate will have strong knowledge of infusion therapy plans and surgical case requirements, with the ability to communicate effectively with payers, practices, and internal departments.

Responsibilities

• Manage end-to-end authorization processes for infusion and surgical cases.
• Review clinical documentation to ensure accuracy and completeness prior to submission.
• Collaborate with providers and departments to gather necessary medical information.
• Submit authorization requests to payers, following both written and verbal communication protocols.
• Serve as a liaison between payers and NYU practices/departments, with emphasis on written correspondence for internal communication.
• Initially focus on IBS infusion cases, with scope expanding to more complex therapies and surgical procedures.
• Track and monitor authorization status to ensure timely approvals and prevent delays in patient care.
• Maintain compliance with payer requirements, clinical standards, and organizational policies.

Requirements

• Registered Nurse (RN) / MBBS/ Clinician required.
• Minimum 2-3 years of clinical experience, preferably in infusion therapy or surgical services.
• Prior experience with payer authorization processes strongly preferred.
• Strong understanding of infusion therapy plans and surgical case workflows.
• Excellent written and verbal communication skills.
• Ability to work independently, manage multiple priorities, and meet deadlines.
• Proficiency with electronic medical records (EMR) and payer portals.
• Work Schedule
• Must be available to work U.S. hours, 8 AM - 6 PM EST.
• Flexibility to adjust based on case volume and payer response times.
• Minimum Qualifications & Competencies:
• RN or MD degree with strong clinical knowledge - Active unrestricted clinical license in at least one state within the United States.
• Minimum of 5 years recent acute-care hospital experience, preferred.
• Minimum of 2 years Utilization Review / Case Management experience within the last 5 years.
• Managed care payor experience a plus either in Utilization Review, Case Management or Appeals.
• Must have excellent written communication skills and be computer proficient.
• PHYSICAL DEMANDS:

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