Supervisor, Appeals – Michigan

McLaren; Flint (MI); Hybrid; USD 65,000 - 95,000; Full time

Job summary

McLaren Health Plan seeks a Supervisor, Appeals to lead the appeals and grievances team and ensure compliance with State and NCQA regulations. You will develop procedures, monitor performance, and coordinate training to improve efficiencies across the department.

The role requires on-site presence in Flint, MI on a hybrid schedule. Prior supervisory experience in managed care is preferred to drive quality service for members and regulators.

Qualifications

• Associate degree or higher in business or health care with related experience.
• Two years of experience in an HMO/Managed Care operations role.
• Supervisory experience preferred for larger staff.

Responsibilities

• Provide overall supervision to appeals and grievances operations.
• Ensure compliance with State and NCQA Appeals regulations.
• Develop policies and procedures for Appeals Department.
• Create training programs and monitor staff performance.
• Implement workflows to improve department efficiency.

Skills

Supervisory experience

Staff training

Regulatory compliance

Education

Associate degree in business/health care

High school diploma with 2 years related experience

Bachelor's degree in business/health care

Job description

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 a Supervisor, 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.

Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org

Position Summary:

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
• Hours Per Pay Period: 80
• On Call: No
• Weekends: No