RN Manager, Grievances & Appeals - Lead Quality & Compliance

MedStar Health; Columbia (MD); On-site; USD 90,000 - 120,000; Full time

Job summary

MedStar Health in Maryland and the District of Columbia is seeking an RN Manager, Grievances and Appeals to oversee intake clinical and claims appeals, complaints, and grievances. You will lead process development to meet regulatory standards while improving quality, efficiency, and team performance.

The role requires a Maryland RN license, CCM certification within 1 year, and 3–7 years of utilization management and diverse clinical experience, plus 2 years of supervisory experience.

Qualifications

• RN license in MD upon hire and DC license before start date.
• CCM certification required within 1 year from date of hire.
• 3-4 years Utilization management experience.
• 5-7 years diverse clinical experience in a hospital or medical setting.
• 2 years supervisory experience.
• 2 days onsite per week.

Responsibilities

• Oversee intake clinical and claims appeals, complaints, and grievances operations.
• Lead development and execution of regulatory-compliant processes to improve quality and efficiency.
• Provide guidance on complex issues, allocate resources, and support continuous improvement.
• Collaborate with leadership to enhance team performance.

Skills

RN license

CCM certification

Case management

Utilization management

Supervisory experience

On-site work

Education

Bachelor's degree in Nursing

Job description

MedStar Health in Maryland and the District of Columbia is seeking an RN Manager, Grievances and Appeals to oversee intake clinical and claims appeals, complaints, and grievances. You will lead process development to meet regulatory standards while improving quality, efficiency, and team performance.

The role requires a Maryland RN license, CCM certification within 1 year, and 3–7 years of utilization management and diverse clinical experience, plus 2 years of supervisory experience.