Remote Appeals & Grievance Manager - LPN Clinician

GlobalHealth; Oklahoma City (OK); À distance; USD 65 000 - 90 000; Plein temps

Résumé du poste

GlobalHealth seeks an experienced clinical operations leader to provide daily leadership and ensure adherence to Appeals and Grievances regulatory requirements. You will monitor workflows, coach staff, handle escalations, and report critical metrics while maintaining PHI confidentiality.

Remote work is available with occasional travel; you will collaborate with leadership to drive process improvements and ensure timely resolutions for member appeals and grievances.

Qualifications

• Licensed Practical Nurse (LPN) license required.
• Associates or Bachelors degree in a related field preferred.
• Experience in Appeals & Grievances or call center reporting is ideal.

Responsabilités

• Schedule and balance resources to match demand.
• Monitor and oversee appeals and grievances processes.
• Handle escalations for member issues.
• Manage employee time and attendance.
• Provide coaching and training to A&G team.
• Produce daily critical-metric reports and analyze workflow.

Connaissances

Prioritization

Detail-oriented

Documentation

HIPAA compliance

Process improvement

Analytical thinking

Formation

LPN License

Associate or Bachelor’s degree

Outils

MS Office

Power BI

Mitel

Epic

Description du poste

GlobalHealth seeks an experienced clinical operations leader to provide daily leadership and ensure adherence to Appeals and Grievances regulatory requirements. You will monitor workflows, coach staff, handle escalations, and report critical metrics while maintaining PHI confidentiality.

Remote work is available with occasional travel; you will collaborate with leadership to drive process improvements and ensure timely resolutions for member appeals and grievances.