Senior Appeals & Complaints Branch Leader

Commonwealth of Kentucky; Frankfort (KY); Hybrid; USD 78,000 - 88,000; Full time

Job summary

The Commonwealth of Kentucky, Cabinet for Health and Family Services, Department for Medicaid Services, in Frankfort, seeks an experienced Human Services Program Branch Manager to lead the Appeals and Complaints Branch. Hybrid telecommuting may be approved; onsite presence is required three days weekly.

The role requires a bachelor’s degree and at least five years of relevant experience in human services administration, with strong supervisory and regulatory compliance skills.

Qualifications

• Knowledge of Medicaid programs, eligibility and managed care requirements.
• Understanding of federal and state laws governing appeals, complaints and hearings.
• Experience in supervision, training, and performance management.

Responsibilities

• Provide leadership and Oversight for the Appeals and Complaints Branch.
• Coordinate External Independent Third-Party Review (EITPR) and administrative hearings.
• Ensure timely processing of appeals and hearing-related matters within federal/state timeframes.
• Supervise and develop branch staff, promoting collaboration and accountability.
• Monitor workload, performance, case status, and deadlines for timely resolutions.
• Review complex cases and provide guidance to staff.
• Coordinate with internal divisions, legal, program staff, health plans and providers.
• Identify recurring issues and recommend process improvements.
• Ensure branch operations comply with laws, regulations and Medicaid requirements.
• Develop procedures for consistency, efficiency, quality and documentation.
• Prepare and review reports and correspondence related to EITPRs and hearings.
• Represent the branch in meetings and communicate needs to leadership.
• Support training and quality assurance activities.

Skills

Medicaid program knowledge

Regulatory compliance

Case management principles

Staff supervision

Performance monitoring

Stakeholder communication

Process improvement

Education

Bachelor's degree

Job description

The Commonwealth of Kentucky, Cabinet for Health and Family Services, Department for Medicaid Services, in Frankfort, seeks an experienced Human Services Program Branch Manager to lead the Appeals and Complaints Branch. Hybrid telecommuting may be approved; onsite presence is required three days weekly.

The role requires a bachelor’s degree and at least five years of relevant experience in human services administration, with strong supervisory and regulatory compliance skills.