Program Manager - Clinical Denials

Work setup: ONSITE / BGC, Taguig within 6 months then transfer to Bridgetowne, QC

Work schedule: Nightshift

The Program Manager – Clinical Denials provides strategic and operational leadership for one or more clinical denials programs across clients, facilities, service lines, or revenue cycle functions.

This position is responsible for program performance, financial recovery, denial prevention, client relationships, operational governance, process standardization, and strategic initiatives. The Program Manager translates denial data and clinical insights into enterprise-level solutions that improve reimbursement, reduce avoidable denials, and strengthen revenue cycle performance.

Qualifications:

Required

• Bachelor’s degree in nursing, Healthcare Administration, Health Information Management, or related field.
• Active RN license or applicable clinical credential.
• 7+ years of healthcare experience, with substantial experience in clinical denials, CDI, RCM, utilization management, appeals, or reimbursement.
• 3+ years of progressive leadership/management experience.
• Demonstrated experience managing large-scale programs, multiple teams, or complex client engagements.
• Strong understanding of inpatient DRG, medical necessity, level of care, clinical validation, coding, reimbursement, and payer poli