Grievances & Appeals Operations Manager

SHPCA SCAN Health Plan; City of Long Beach (NY); Presencial; USD 80.000 - 116.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Annual bonus program

Generous PTO

11 paid holidays per year

Excellent 401(k) retirement plan with

Tuition reimbursement

Descripción de la vacante

SCAN Health Plan seeks a Manager of Grievances and Appeals Operations to lead the day-to-day activities of the program, ensuring compliant, timely handling of member grievances and appeals. You will manage staff, develop workflows, monitor metrics, and drive process improvements in coordination with the Medical Director and stakeholders.

The role requires a Bachelor's in healthcare, 5+ years in managed care, strong leadership, and excellent communication skills.

Formación

• Bachelor's Degree or equivalent experience in Healthcare or human service-related field of study.
• 5+ years in managed health care setting, Medicare/Medicaid preferred.
• Excellent presentation skills, group motivation and supervisory skills.
• Strong strategic planning, critical thinking and leadership skills.
• Demonstrated management experience.
• Experience coordinating diverse groups of individuals to achieve success of the overall program.
• Ability to prioritize multiple and competing tasks, work independently and in a team environment.
• Ability to work well in a fast-paced and dynamic environment.
• Strong interpersonal skills, including excellent written and verbal communication skills.
• Strong organizational skills.
• Ability to multitask.
• Ability to appropriately maintain confidentiality.
• Strong analytical and critical thinking skills, required.
• Working knowledge of guidelines and regulations relevant to Grievance and Appeals including Medicare, Medi-Cal, DMHC, DHCS, and NCQA Guidelines.
• Demonstrated ability to work with all levels of staff, within and external to the organization to achieve goals.
• Microsoft Office Suite experience at advanced level.

Responsabilidades

• Manage day-to-day operations of the SCAN Grievance and Appeal program to ensure timely delivery.
• Oversee staff productivity and implement process improvements for compliance.
• Train staff on review workflows, case classification, and escalation to pharmacists or Medical Director.
• Coordinate staff meetings and interdisciplinary team collaboration.
• Develop and monitor department metrics for productivity and efficacy.
• Represent the department on committees and coordinate with the Medical Director for quality case reviews.
• Recruit, orient, and train staff; maintain a safe and secure work environment.

Conocimientos

Leadership

Strategic planning

Communication

Management experience

Healthcare background

Project management

Analytical thinking

Multitasking

Educación

Bachelor's Degree in Healthcare or related field

Herramientas

MS Office Suite

Descripción del empleo

SCAN Health Plan seeks a Manager of Grievances and Appeals Operations to lead the day-to-day activities of the program, ensuring compliant, timely handling of member grievances and appeals. You will manage staff, develop workflows, monitor metrics, and drive process improvements in coordination with the Medical Director and stakeholders.

The role requires a Bachelor's in healthcare, 5+ years in managed care, strong leadership, and excellent communication skills.