Supervisor, Appeals - Michigan

Karmanos Cancer Institute; Flint (MI); Hybrid; USD 60,000 - 90,000; Full time

Job summary

McLaren Health Care in Flint, MI is seeking a Supervisor, Appeals to lead the appeals and grievances operations within McLaren Health Plan. This role focuses on ensuring regulatory compliance and efficient workflows across the department.

The successful candidate will oversee staff, develop policy, monitor performance, and prepare reports for leadership and regulators. This is a full-time, hybrid on-site position located in Flint, Michigan.

Qualifications

• Associate degree in business, health care or related field; or high school diploma with two years of related experience.
• Two years’ experience in an HMO/Managed Care operations role (i.e. claims, quality).
• Bachelor’s Degree in business, health care or related field (preferred).
• Two years’ supervisory experience leading a staff of five or more.
• Five years progressive leadership experience in group health plan operations (preferred).
• Three years’ experience in HMO/Managed Care accreditation processes (e.g., NCQA) (preferred).

Responsibilities

• Provide overall supervision to appeals and grievances operations and ensure regulatory compliance.
• Develop and implement policies and procedures to ensure compliance with Appeals regulations.
• Create, adjust, and optimize workflows to improve department efficiency.
• Complete reports and statistics for senior management, regulators, auditors, and accrediting agencies.
• Analyze and implement training for staff.
• Monitor staff performance and take corrective action as needed.

Skills

Supervisory experience

Leadership

Staff training

Recruitment

Performance management

Training

Education

Associate degree in business, health care or related field

High school diploma with two years of related experience

Bachelor’s Degree in business, health care or related field

Job description

McLaren Health Care, headquartered in Grand Blanc, Michigan, is a $7.3 billion, fully integrated health care delivery system committed to quality, evidence-based patient care and cost efficiency. The McLaren system includes 12 hospitals in Michigan, ambulatory surgery centers, imaging centers, a 640-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering more than 732,838 lives in Michigan and Indiana, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, a National Cancer Institute-designated comprehensive cancer centers. McLaren has 20,000 full-, part-time and contracted employees and more than 113,000 network providers throughout Michigan, Indiana and Ohio.

McLaren Health Plan (MHP) is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking for aSupervisor, Appeals to join in leading the organization forward.

MHP is a Managed Care Organization dedicated to meeting the health care needs of each member.MHP offer multiple product lines, including employer plans, individual and family plans, and Medicaid and Medicare plans to Michigan residents for every stage of life. McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA).

MHP values the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plan can thrive. As an employee of MHP, you will be part of a dynamic organization that considers all out employees as leaders in driving the organization forward and delivering quality service to all our members.

Provides overall supervision to appeals and grievances operations, maintains compliance with State and NCQA Appeals regulations, and assists with the appeals activities in coordination of the delivery of health care services of the Plan. Develops and implements policies and procedures to ensure compliance of the Appeals Department. Completes reports and statistics for senior management, state regulators, auditors, compliance, and accrediting agencies as needed. Responsible for analyzing, developing, and implementing training for staff. Creates, implements, and adjusts workflows to ensure efficiencies within the department and are externally maintained. Responsible for monitoring staff performance relative to state, federal, legal, and accrediting standards and implements corrective action plans as needed.

This is a hybrid position with requirements to come on site as scheduled, Flint, MI.

Qualifications

Required:

• Associate degree in business, health care or related field; or high school diploma with two (2) years of related experience.
• Two (2) years’ experience in an HMO/Managed Care operations role (i.e. claims, quality).

Preferred

• Bachelor’s Degree in business, health care or related field.
• Two (2) years’ experience in a supervisory role for a staff of five or more members leading or assisting in all phases of effective supervision (ie. Recruitment, performance management, training).
• Five (5) years progressive experience in a leadership role in group health plan operations.
• Three (3) years’ experience in HMO/Managed Care accreditation process, such as NCQA, etc.

Additional Information

• Schedule: Full-time
• Daily Work Times: 8:30 am - 5:00 pm
• On Call: No

McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.

McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employmentwithout regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status,national origin, disability, genetic information, height or weight, protected veteran or other classificationprotected by law.