Manager of Appeals and Grievances

Job Summary

A company is looking for a Manager, Appeals and Grievances.

Key Responsibilities

• Monitor and manage intake for specialty appeals and oversee non-clinical staff training and performance
• Facilitate adherence to timeliness and accuracy standards, while managing staff productivity and work assignments
• Consult with clinical and claims staff on problem cases and assist in data gathering for reports and audits

Required Qualifications

• Management experience in a health care setting, preferably in Utilization Management
• Minimum of 5 years in Utilization Management, health care appeals, compliance, or grievances in a quality improvement environment
• Strong working knowledge of Microsoft Office products
• Experience in training and developing staff in specialized tasks
• Ability to analyze reports regarding appeal and provider dispute activity