Grievance & Appeals Strategy Manager (Medicare)

CareSource; United States; Remote; USD 83,000 - 133,000; Full time

Job summary

CareSource seeks a Manager, Grievance and Appeals to lead the Grievance, Appeal, IRE/IRO and State Hearing teams in a complex Medicaid/Medicare environment. You will drive regulatory compliance, data reporting, and ongoing process improvements across lines of business.

The role requires a bachelor’s degree or equivalent experience, 3+ years of management, and 4+ years in grievances and appeals. Strong leadership and communication skills are essential to succeed in this fast-paced setting.

Qualifications

• Bachelor’s degree or equivalent years of relevant work experience.
• Minimum of three (3) years of management experience preferred.
• Minimum of four (4) years of grievance and appeals experience preferred.

Responsibilities

• Provide leadership and direction to staff to ensure the goals and standards of the department and CareSource are successfully achieved
• Manage staff to ensure timely and accurate completion of tasks and issues are accomplished
• Oversee and monitor processes to ensure department is meeting all regulatory requirements and accreditation standards
• Oversee and ensure grievances and appeals are resolved and reported appropriately
• Oversee, analyze and provide feedback to all areas that submit grievances and appeals
• Develop, implement and execute grievances and appeals training to business areas as needed
• Analyze and evaluate operations and identify process improvement
• Identify irregular trends with grievances and appeals; work with other areas as appropriate to identify root causes and appropriate steps for resolution
• Monitor trends and regulatory changes for impact to the department
• Report data to appropriate committees with CareSource
• Oversee, develop and execute the grievances and appeals process for new product lines
• Review and interpret regulatory requirements and ensure business policies and processes are in compliance
• Lead initiatives to track and trend grievances and appeals data in order to drive process improvements
• Develop a culture of accountability and flexibility within the team to support the organizational mission and vision
• Perform any other job duties as requested

Skills

Staff leadership

Effective communication

Problem solving

Strategic thinking

Education

Bachelor's degree or equivalent experience

Tools

MS Office Suite

ACD systems

Call Management Systems

Job description

CareSource seeks a Manager, Grievance and Appeals to lead the Grievance, Appeal, IRE/IRO and State Hearing teams in a complex Medicaid/Medicare environment. You will drive regulatory compliance, data reporting, and ongoing process improvements across lines of business.

The role requires a bachelor’s degree or equivalent experience, 3+ years of management, and 4+ years in grievances and appeals. Strong leadership and communication skills are essential to succeed in this fast-paced setting.