Senior Manager, Clinical Appeals (Remote FL)

NTT DATA, Inc.; Tampa (FL); Hybrid; USD 84,000 - 103,000; Full time

Benefits offered by this job

Medical, dental, vision insurance

Flexible spending account / HSA

401(k) with company match

Paid time off

Job summary

NTT DATA, Inc. seeks a BPO Senior Manager in Tampa, FL to lead a Clinical Reviewers team supporting appeals and utilization management. The role requires RN licensure, healthcare knowledge, and the ability to drive performance and process improvements.

Remote work available for Florida residents; we offer comprehensive benefits, 401(k) with company match, and a focus on quality and patient advocacy. Salary is $93,600 annually.

Qualifications

• 5 years of experience in appeals management, utilization management, or clinical review operations.
• 1 year of leadership experience in a supervisory or team lead role.
• Strong knowledge of utilization management and NCQA standards.
• Excellent written and verbal communication skills and ability to lead a team.

Responsibilities

• Lead, coach, and develop a team of Clinical Reviewers responsible for appeals and utilization management activities.
• Provide training, mentorship, and guidance on clinical review processes and medical necessity determinations.
• Monitor team performance, productivity, quality, and compliance with SLAs.
• Allocate case assignments and ensure timely turnaround times.
• Ensure compliance with contractual, regulatory, and accreditation requirements in appeals outcomes.
• Collaborate with stakeholders to improve procedures and reduce issues, while maintaining patient advocacy.

Job description

NTT DATA, Inc. seeks a BPO Senior Manager in Tampa, FL to lead a Clinical Reviewers team supporting appeals and utilization management. The role requires RN licensure, healthcare knowledge, and the ability to drive performance and process improvements.

Remote work available for Florida residents; we offer comprehensive benefits, 401(k) with company match, and a focus on quality and patient advocacy. Salary is $93,600 annually.