Supervisor Appeals RN

· Conduct quality audits and case reviews to assess accuracy, consistency, and compliance.

· Identify trends, root causes, and opportunities for process improvement.

· Develop and implement corrective actions to address quality concerns and performance gaps.

· Monitor overturn trends and identify opportunities to improve initial review accuracy.

The position is responsible for monitoring quality indicators, identifying trends, presenting data during regulatory performance workgroups, supporting corrective actions, and advancing operational excellence and compliance.

· Hire, train, mentor, and develop clinical appeals staff.

· Conduct performance evaluations and coaching sessions.

· Identify developmental opportunities to enhance regulatory, clinical, and operational knowledge.

· Lead staff meetings, case discussions, calibration activities, and educational programs.

· Foster a culture of accountability, quality, collaboration, and member advocacy.

· Active, unrestricted Registered Nurse (RN) license.

· Bachelor's Degree in Nursing (BSN) required.

· 5+ years of clinical appeals, utilization management, or healthcare operations experience.

· 3+ years of Commercial Appeals & Grievances experience within a health plan environment.

· Prior leadership, supervisory, team lead, or management experience.

· Experience managing complex clinical appeals and external review processes.

· Experience supporting audits, accreditation reviews, or compliance monitoring programs.

At IBX, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.

At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com . We’re revolutionizing health care, and our focus is on you!

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

All resumes submitted directly to an Independence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.