Tennr is a patient orchestration platform that helps providers get the right patients into the right care settings at the right time. Backed by Lightspeed, Y Combinator and a16z.
About the role
Review and triage customer feedback related to qualification criteria, medical necessity logic, documentation requirements, and payer policy interpretation. Review custom criteria requests and translate clinical requirements into clear internal guidance for criteria writers, reviewers, and customer-facing teams.
What they're looking for
- 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
- Familiarity with LCDs, NCDs, HCPCS, CPT, ICD-10, denial review, or criteria-heavy workflows like DME/HME, infusion, or specialty pharmacy is a plus
More about this role
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. And wait. Sometimes days, weeks, or even months. Why? 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.
We're seeking a Clinical Criteria Escalations Specialist to support our Qualifications team, the product customers rely on to evaluate medical necessity and documentation requirements. In this role, you'll own customer feedback, custom criteria requests, and clinical escalations, determining whether feedback represents a true criteria issue, a payer policy interpretation question, a documentation gap, or a customer-specific preference, and turning it into clear, actionable guidance.
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...
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