Appeals Manager

CNSI and Kepro are now Acentra Health! Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. 

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. 

Acentra is looking for a Appeals Manager to join our growing team.

Job Summary:

The purpose of this position is to oversee the clinical team and to manage and complete assigned work plan projects to comply with performance standards. This role will oversee the Mediation and Appeals Team who manage a caseload of assigned cases to ensure that mediations are scheduled, mediations are performed within timelines and data is entered into QiRePort and the Mediation Tracker within prescribed timelines. The Clinical Manager coordinates with the Directors and Program Leads on decisions and issues, and communicates with the team, NC MCD and the Attorney General’s Office as appropriate regarding determinations and other clinical matters. The Clinical Manager also develops and leads clinical staff in activities to facilitate and support clinical, quality, and cost-effective outcomes.

Job Responsibilities:

• Oversee, coordinate, and monitor all Clinical team activities.
• Ensure adequate staffing and contractual service levels are adhered to by implementing and monitoring clinical staff productivity and performance indicators. Maintains effective team member relations.
• Leads team members in improving skills, creativity, and problem-solving.
• Work with management team to develop and enhance the operational structure including skill set requirements, gap analysis, and training using workforce planning.
• Manages and completes assigned work plan objectives and projects on a timely basis.
• Provide advice and assistance to leaders in the planning, implementation, and evaluation of modifications to existing operations, systems, and procedures. Collaborate with leadership in the development of new and enhanced products and services.
• Represents the clinical department by participating on committees, task forces, work groups, and multidisciplinary teams.
• Maintains professional relationships with provider community and external customers and identifies …