Director of Grievance and Appeals

Job Summary

Overseeing the appeals and grievance processes, the full-time remote Director of Grievance and Appeals will manage departmental operations, ensure compliance with regulations, and implement performance improvements while minimizing legal risks.

Key responsibilities:

• Direct and manage the appeals and grievance department to enhance operational efficiency and outcomes
• Design and implement processes and policies to ensure compliance with regulations and address performance issues
• Analyze data to identify trends in appeals and grievances and present findings to leadership

Required qualifications:

• Bachelor's degree or equivalent work experience is required; Master's degree preferred
• Minimum of five years of management experience in a healthcare operational environment is required
• Experience in managed care is required
• Direct leadership experience in a Grievance and Appeals setting is required
• Senior management experience is preferred