Lead, Clinical Appeals & Grievances Operations

Healthfirst; Pennsylvania; On-site; USD 89,000 - 132,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401k

Job summary

Healthfirst seeks a Manager of Clinical Appeals & Grievances to lead a fast-paced team and coordinate with organizational leaders to optimize processes and drive performance. The role oversees internal and external production and ensures high quality and compliance across all levels.

The position requires a Bachelor’s degree (RN preferred) with experience in utilization management or appeals, and a track record of leading teams in complex healthcare environments.

Qualifications

• Bachelor's degree or equivalent work experience.
• RN credential required.
• Experience with utilization management or appeals and grievance processing and compliance.
• Fast-paced environment overseeing multiple priorities, tasks and teams.
• Ability to problem solve and improve processes.

Responsibilities

• Lead and develop a dynamic Appeals & Grievances team.
• Ensure timely resolution of cases and compliance with policies.
• Oversee production teams and coordinate with internal/external stakeholders.
• Drive process improvements and vendor management.

Skills

Leadership

Education

Bachelor's degree

MBA or master's degree

Job description

Healthfirst seeks a Manager of Clinical Appeals & Grievances to lead a fast-paced team and coordinate with organizational leaders to optimize processes and drive performance. The role oversees internal and external production and ensures high quality and compliance across all levels.

The position requires a Bachelor’s degree (RN preferred) with experience in utilization management or appeals, and a track record of leading teams in complex healthcare environments.