Manager, Complex Clinical Review (Healthcare)

Location: Remote - US; candidates must work from within the United States

Salary: $115,000–$130,000 USD base salary per year

Company

hirify.global is a healthcare intelligence company providing an AI-powered platform and clinical expertise to health plan clients, supporting payment integrity and healthcare cost reduction.

What you will do

• Lead the Complex Clinical Bill Review team, overseeing production expectations, SLAs, client communication, assignments, and performance.
• Manage clinical review concepts including medical appropriateness, level of care, pharmacy utilization, experimental and investigational services, and medical policy adherence.
• Analyze business requirements and workflows, identify process issues, and coordinate solutions with development teams.
• Coordinate system enhancements through JIRA ticket creation, user acceptance testing, and production implementation.
• Monitor team metrics, quality, productivity, training needs, and audit standards; conduct quality assurance reviews as needed.
• Manage staff performance, onboarding, meetings, training, cross-functional coordination, client issues, and clinical appeal dispute resolution.

Requirements

• Current, unrestricted nursing license in good standing.
• At least 3 years of experience performing clinical audits of itemized bills.
• At least 3 years of diverse nursing experience in an inpatient or outpatient setting.
• Preferred: 3+ years of supervisory or leadership experience, including experience managing remote staff.
• Experience with healthcare software products, process development, project management, and collaboration with development teams.
• Strong knowledge of audit standards, medical chart reviews, policies, regulations, Microsoft Office, Excel, and Teams.

Nice to have

• Certified coding certification.
• Experience managing remote staff.

Culture & Benefits

• Digital-first, remote work from anywhere in the US.
• Medical, dental, and vision coverage for employees and families.
• Unlimited flexible time off.
• Flexible and trusting work environment.
• Competitive salary, equity, and 401(k) with employer match.