Licensed Nurse Manager, Grievances

Job Summary

Licensed Nurse Manager, Grievances is a full-time remote position responsible for managing member and provider complaints and grievances, ensuring compliance with regulatory standards, and implementing corrective action plans.

Key Responsibilities

• Track, trend, analyze, and report on member complaints and grievances, performing root cause analysis as needed
• Ensure timely and accurate completion of monitoring reports and manage day-to-day operations of the complaints and grievances process
• Represent the organization in internal and external forums and support the implementation of the appeals tracking system

Required Qualifications

• Bachelor's degree in business, health care, management, or a related field, or equivalent relevant experience
• 4 years or more of experience in process-oriented operations or project-oriented management
• One year of supervisory experience is required
• Experience with member and practitioner complaint/grievance processes is preferred
• Licensed Registered Nurse is preferred