Tennr
Clinical Criteria Escalations Specialist
New York City Office
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About the role
- This is a great fit for an RN or LPN with experience in utilization management, prior authorization, clinical appeals, CDI, medical necessity review, or payer policy review.
- You should be comfortable reading payer policies, reviewing clinical documentation, and making sense of ambiguous feedback with strong clinical judgment.
Responsibilities
- Partner with internal teams to resolve criteria-related escalations and close the loop on customer feedback.
- Drive Impact: one of our company values is Cowboy, meaning you set the pace. You won't just talk about things, you'll get them done. And feel the impact.
- Develop Operational Expertise: learn the inner workings of scaling systems, tools, and infrastructure
Requirements
- Active RN or LPN license.
- Experience in utilization management, prior authorization, medical necessity review, clinical appeals, payment integrity, CDI, payer policy review, or DME/HME qualification review.
- Strong understanding of medical necessity, payer policy, and clinical documentation, with the ability to distinguish policy-backed requirements from customer preference or workflow variation.
- Strong written communication, attention to detail, and judgment around when to resolve, document, or escalate.
- Free lunch! Plus a pantry full of snacks.
Nice to have
- Familiarity with LCDs, NCDs, HCPCS, CPT, ICD-10, denial review, or criteria-heavy workflows like DME/HME, infusion, or specialty pharmacy is a plus.
- Plus a pantry full of snacks.
Benefits
- 100% paid employee health benefit options
- Competitive parental leave
- Review and triage customer feedback related to qualification criteria, medical necessity logic, documentation requirements, and payer policy interpretation.
- At Tennr, you'll join a high-caliber team maniacally focused on reducing patient delays across the U.S. healthcare system.
Company info
- Today, when you go to your doctor and get referred to a specialist, your doctor sends out a referral and tells you, "They'll be in touch soon." So you wait.
- Sometimes days, weeks, or even months.
- Because too often providers are overwhelmed with the painstakingly tedious work required to get paid by insurance companies.
- Powered by proprietary models, Tennr handles the complex paperwork that gets patients through the door and providers paid, helping operators get patients the right care, at the right time, in the right setting.
This listing is sourced directly from Tennr's careers page and normalized into a canonical job model.