Strategic Grievances & Appeals Manager (Hybrid)

VNS Health; New York (NY); Hybrid; USD 85,000 - 106,000; Full time

Benefits offered by this job

Referral bonus opportunities

30 days PTO + 9 holidays

Health insurance for you and family

Employer-matched retirement savings

Pre-tax FSAs for healthcare and DEP C

Tuition reimbursement

Career advancement opportunities

Internal mobility and CEU credits

Job summary

VNS Health is seeking a managerial professional to oversee grievance and appeals operations across MLTC, MA, FIDA, and Select Health product lines. The role ensures regulatory compliance and readiness for audits, while coordinating with cross-functional teams to resolve complex cases.

The position emphasizes oversight of data integrity, external reviews, and subcontractor management, with opportunities for professional growth and staff development in a hybrid work environment.

Qualifications

• Bachelor's degree in health/human services, healthcare or business administration or related field; required.
• Master's Degree in public health or health-related field preferred.

Responsibilities

• Manage the intake, investigation and resolution of member grievances and appeals.
• Track grievances and appeals and maintain logs and records.
• Coordinate with Provider Relations, Claims, Medical Director and third parties to resolve appeals and grievances.
• Ensure data collection and reporting systems support CMS/DOH reporting and analysis.
• Supervise subcontractors handling delegated grievance and appeal responsibilities.
• Develop and implement policies, procedures and workflows for grievances and appeals.
• Monitor regulatory trends and recommend improvements.
• Lead staff training and scheduling, and oversee budget and staffing decisions.

Skills

Oral and written communication

Computer literacy

Education

Bachelor's degree in health/healthcare or business administration

Master's degree in public health or health-related field (preferred)

Tools

MS Office

FACETS system

Job description

VNS Health is seeking a managerial professional to oversee grievance and appeals operations across MLTC, MA, FIDA, and Select Health product lines. The role ensures regulatory compliance and readiness for audits, while coordinating with cross-functional teams to resolve complex cases.

The position emphasizes oversight of data integrity, external reviews, and subcontractor management, with opportunities for professional growth and staff development in a hybrid work environment.