30 Aug
Mgr I Grievance/Appeals-Office Based (PS38700)
California, Newburypark 00000 Newburypark USA

Vacancy expired!

Description SHIFT: Day JobSCHEDULE: Full-timeManager I Grievance/Appeals This position is an office based role in Woodland Hills, CA-Open to Newbury Park, CA. Due to COVID offices are closed and this position will start remote until the offices are back open. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed. Responsible for management oversight of receipt, investigation and processing associated with member/provider grievance and appeals. Primary duties may include, but are not limited to:

Monitors, trends and analyzes grievance and appeals data for submission to appropriate parties.

Serves as clinical resource expert and mentor to unit and other departments for complex issues and interpretation of regulatory standards.

May perform internal audits of grievance and appeals process. Ensures appeals and grievances are resolved within regulatory time frames.

Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Qualifications Qualifications:

Requires 3-5 years leadership experience in grievance & appeals, claims or customer services in the healthcare industry; or any combination of education and experience, which would provide an equivalent background. BA/BS preferred.

For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Must be able to sit onsite in Woodland Hills, CA when offices are back open.

Experience with DMHC preferred

AnEqualOpportunityEmployer/Disability/VeteranREQNUMBER: PS38700-NP

Vacancy expired!


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