Manager, RN Clinical Appeals

Novocure

Posted on: August 5, 2022

Closing: September 04, 2022

Salary: Undisclosed

Position Type: Full Time

Job Description

The Manager, RN Clinical Appeals is responsible for the oversight of a team of RN’s with a primary focus of ensuring we are in compliance with contractual and regulatory requirements, as well as representing Novocure on external ALJ hearings. This position will build and manage relationships with external and internal partners and will collaborate with, and support, the other Revenue Operations functional teams.

This is a full-time, exempt position reporting to the Director of Government Reimbursement and is based in Portsmouth, NH.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Oversee the day to day operation for the Nurse Appeals team within Revenue Operations.  Establishes team goals by working with the direct reports and ensures that goals are achieved.  Accountable for quality, productivity and timeliness of the work performed
  • Ensure timely and accurate clinical documentation review is performed in accordance with department policies
  • Support the Medicare appeals process through collaboration with Manager of Government Reimbursement via the communication of issues and recommended solutions to improve the overturn rate of appeals
  • Ensure that Novocure has proper clinical representation and adequate coverage for Administrative Law Judge (ALJ) hearings
  • Establish and maintain positive working relationships with internal and external  partners
  • Develop ongoing Clinical Appeals RN education requirements, career development plans, and competency trainings.
  • Monitor team specific KPI’s and provide monthly analysis and reporting on trends.  Identify areas of risk as well as process opportunities.
  • Maintain up-to-date knowledge of regulatory changes impacting clinical appeals requirements and ensures appeals staff are appropriately educated.
  • Support internal and external audits as necessary
  • Perform all other duties or priorities assigned by senior management

QUALIFICATIONS/KNOWLEDGE:

  • 6-10 years in a medical device or DME company and/or Gov’t/Medicare appeal clinical background
  • Bachelor’s degree or equivalent experience, RN preferred
  • Ability to lead and motivate a team in a coaching environment
  • Excellent knowledge of government and commercial appeals process preferred
  • Strong knowledge of medical and oncology regulatory environments preferred
  • Strong leadership skills with an ability to motivate a team
  • In-depth understanding of medical terminology, specific to oncology preferred
  • Experience with Microsoft Office and SAP preferred
  • Exceptional written and verbal communication skills
  • Demonstrated excellence in meeting and exceeding customer expectations
  • Effectiveness in de-escalating and resolving difficult situations
  • Ability to solve problems and set priorities
  • Ability to work independently with minimal supervision
  • Ability to work cooperatively in a fast-paced office setting

OTHER:

  • Ability to lift up to 20 pounds
  • Ability to travel 5%

Novocure is taking a responsible approach to creating environments that allow us to strive to extend survival in some of the most aggressive forms of cancer by developing and commercializing our innovative therapy.

As part of our commitment to health and safety, COVID-19 vaccines are required for our current U.S. employees.  As an Equal Opportunity Employer it is our policy to provide reasonable accommodations to any qualified individual, who, because of a medical condition, or sincerely held religious belief/practice, receives an exemption from the vaccination requirement, if such accommodation would not result in an undue hardship for the company.

For more information regarding the Novocure’s COVID-19 vaccination requirement, exemptions, and verification of vaccination status please ask the Talent Acquisition Team.

ABOUT NOVOCURE:

Our vision

Patient-forward: aspiring to make a difference in cancer.

Our patient-forward mission

Together with our patients, we strive to extend survival in some of the most aggressive forms of cancer by developing and commercializing our innovative therapy.

Our patient-forward values

– innovation

– focus

– drive

– courage

– trust

– empathy

Novocure

Posted on: August 5, 2022

Closing: September 04, 2022

Salary($): Undisclosed

Position Type: Full Time

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