Remote Appeals & Grievances Clinical Manager

GlobalHealth, Inc.; Oklahoma City (OK); Remote; USD 70,000 - 110,000; Full time

Job summary

GlobalHealth, Inc. seeks a daily clinical leader to ensure compliance and timely handling of Appeals and Grievances. You will oversee scheduling, escalation management, and staff coaching while maintaining HIPAA safeguards and reporting essentials.

Required are LPN or higher credentials, 3 years in A&G operations, 2 years in appeals/grievances, and proficiency with MS Office; Power BI, Mitel, and Epic are a plus. Remote work with limited travel may apply.

Qualifications

• Licensed Practical Nurse (LPN) licensed to practice.
• Associate degree or bachelor’s degree in a related field.
• 3 years A&G Clinical operations experience required.
• 2 years appeals and grievances required.
• 1 year experience with MS Office, Power BI a plus, Mitel or Epic required.
• Familiarity with process analytics and continuous improvement methods preferred.

Responsibilities

• Schedule and balance resources to match anticipated demand.
• Monitor and oversee appeals and grievances process.
• Handle escalations for member issues.
• Coach and train A&G team.
• Provide daily reporting for critical measures.
• Identify opportunities for workflow improvements.
• Ensure regulatory and contractual compliance.
• Hire, coach and disciplinary actions as required.

Skills

Leadership

Regulatory compliance

Time management

Communication

Education

LPN

Associate or bachelor’s degree

Tools

MS Office

Power BI

Mitel

Epic

Job description

GlobalHealth, Inc. seeks a daily clinical leader to ensure compliance and timely handling of Appeals and Grievances. You will oversee scheduling, escalation management, and staff coaching while maintaining HIPAA safeguards and reporting essentials.

Required are LPN or higher credentials, 3 years in A&G operations, 2 years in appeals/grievances, and proficiency with MS Office; Power BI, Mitel, and Epic are a plus. Remote work with limited travel may apply.