RN Manager Grievances & Appeals - Hybrid

Midland-Marvel Recruiters, LLC; Tacoma (WA); On-site; USD 110,000 - 140,000; Full time

Benefits offered by this job

Sign-on bonus

Relocation assistance

Job summary

A hospital system in Tacoma, WA seeks an experienced RN Manager for Grievances & Appeals to lead Intake, Appeals, and Complaints across all lines of business. This leadership role requires clinical expertise, strong process improvement, and a focus on patient advocacy.

The position offers a sign-on bonus and relocation assistance to the right candidate, with a pathway to advance within a Managed Care environment.

Qualifications

• Bachelor’s degree in Nursing is required.
• 3-4 years in UM and 5-7 years of clinical experience in a hospital or medical setting.
• 2 years of nursing leadership as a supervisor or assistant manager.
• CCM certification active or to be obtained within 1 year.

Responsibilities

• Oversees and provides direction for Intake, Appeals (Clinical and Claims), Retrospective Review, Emergency Room Review, and Customer Service/Complaints/Grievances for all lines of business.
• Responsible for day to day oversight and management of Intake, Clinical Appeals, Claims Appeals, Complaints, Grievances and Intake functions.

Skills

Nursing leadership

Grievances & Appeals

Managed Care Experience

Clinical workflow oversight

Team development

Education

Bachelor’s degree in Nursing

Tools

CCM Certification

Job description

Hospital system looking to bring on RN Manager Grievances & Appeals! Sign On Bonus and Relocation!

• Oversees and provides direction for Intake, Appeals (Clinical and Claims), Retrospective Review, Emergency Room Review, and Customer Service/Complaints/Grievances for all lines of business.


• Responsible for day to day oversight and management of Intake, Clinical Appeals, Claims Appeals, Complaints, Grievances and Intake functions.

Qualifications:

• Bachelor’s degree in Nursing Required


• Experience working in a Managed Care Organization with strong experience in Medicaid


• Specific Experience working with Grievances and Appeals (minimum of 3 years)


• 3-4 years in UM and 5-7 years of clinical experience in a hospital or medical setting


• 2 years of nursing leadership as a supervisor or assistant manager


• CCM - Certified Case Manager Active Certified Case Manager (CCM) or CCM certification within 1 Year Required