Manager, Complex Clinical Review

Machinify
United States
Workplace: RemoteFull timeUSD 115,000 - 130,000Function: Healthcare (Clinical, Medical, Wellness)Skills: ["Leadership","Project management","Interpersonal skills","Communication","Problem-solving"]

Lead the Complex Clinical Bill Review team to ensure SLA performance, production expectations, and consistent audit quality across multiple programs. Use your clinical review and nursing experience to oversee requirements gathering, process improvements, dispute resolution workflows, and training. Partner with Operations and Client Success to resolve client issues quickly, monitor metrics for growth and efficiency, and coordinate system enhancements (including Jira ticketing and UAT) for the clinical review platform.

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FursaFursa
Machinify
Machinify
4 days ago

Manager, Complex Clinical Review

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Source: Company careers pageValidated by: Fursa AI
Last checked: 8 hours agoStatus: Live

Job Summary

Lead the Complex Clinical Bill Review team to ensure SLA performance, production expectations, and consistent audit quality across multiple programs. Use your clinical review and nursing experience to oversee requirements gathering, process improvements, dispute resolution workflows, and training. Partner with Operations and Client Success to resolve client issues quickly, monitor metrics for growth and efficiency, and coordinate system enhancements (including Jira ticketing and UAT) for the clinical review platform.
Location: United States
Workplace: Remote
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)
Seniority: Manager level

Key Responsibilities

  • •Oversee the Complex Clinical Bill Review team, managing production expectations, SLAs, client communication, and team performance.
  • •Continuously evaluate clinical review functionality across programs and ensure efficient, accurate reviews.
  • •Coordinate requirements gathering and problem-solving for process issues that require development attention.
  • •Oversee clinical review concepts (e.g., experimental/investigational, pharmacy utilization, level of care, medical appropriateness, medical policy adherence) and ensure guideline/training adherence.
  • •Manage team execution and quality: performance reviews, meetings, onboarding, training materials/QA processes, dispute resolution, and system enhancements (Jira, UAT, production).

Pay and Benefits

Salary: USD 115,000 - 130,000
Equity and Bonus:Equity
Perks:Health InsuranceDentalVision401kPaid LeaveEquity

Key Requirements

  • •Current, unrestricted nursing license in good standing (certified coding certification is a plus).
  • •3+ years relevant supervisory or leadership experience, including managing remote staff (preferred).
  • •3+ years’ experience performing clinical audits of itemized bills.
  • •3+ years’ diverse nursing experience providing direct care in an inpatient or outpatient setting.
  • •Proven experience with healthcare industry software/products and process development, including strong project management and interpersonal skills.
Experience:HealthcareClinical auditsRemote teams
Skills:LeadershipProject managementInterpersonal skillsCommunicationProblem-solving
Licenses:Unrestricted nursing license
Certifications:Certified coding certification
Tech Stack:JIRAUAT testingWindowsMicrosoft OfficeMicrosoft SuiteTeamsExcel

Company Brief

Machinify
Provides AI-driven predictive maintenance and asset-monitoring solutions for manufacturing and industrial operations, using IoT sensor data and machine learning to reduce downtime, optimize performance, and extend equipment life.
Industry: Industrial Automation
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