Grievance and Appeals Manager
Job Summary
Managing the daily operations of the Grievance and Appeals department, the full-time remote Grievance and Appeals Manager will ensure compliance with legal requirements, monitor trends in appeals and grievances, and serve as the primary contact with state entities.
Key responsibilities
- Ensure timely processing of member and provider appeals in accordance with contractual and legal requirements
- Monitor and report on trends in appeals and grievances to senior management monthly
- Collaborate with external stakeholders to address grievance and appeals issues and integrate regulatory changes
Required qualifications
- Bachelor's degree in a related field or equivalent experience
- 3+ years of experience in healthcare, law, grievances, and appeals
- Previous supervisory experience, including hiring and training staff
- Experience managing cross-functional teams on large-scale projects
Complete Job Description
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