Oregon Licensed Grievance Manager
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Job Summary
Managing the day-to-day operations of the Grievance & Appeals department, the full-time Oregon Licensed Grievance Manager will ensure the appropriate processing of member and provider appeals, serve as the point of contact with the State, and provide monthly reporting on trends while working remotely in alignment with Pacific Standard Time.
Key responsibilities
- Ensure timely processing of all appeals and grievances in accordance with contractual and legal requirements
- Monitor trends in appeals and grievances, providing senior management with monthly reports
- Collaborate with external entities 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, grievances, and appeals
- Active RN licensure in the state of Oregon
- Previous supervisory experience, including managing cross-functional teams
- Experience in developing compliance procedures related to grievances and appeals
Complete Job Description
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