Supervisor, Appeals - Michigan

McLaren Health Care; Flint (MI); Hybrid; USD 60,000 - 90,000; Full time

Job summary

McLaren Health Plan (MHP) is seeking a Supervisor, Appeals to lead the organization forward. This role provides overall supervision to appeals and grievances operations, ensures compliance with state and NCQA regulations, and helps develop training and policies for staff.

Hybrid position with on-site requirements in Flint, MI. Requires an associate degree (or equivalent) and experience in HMO/Managed Care operations; a bachelor’s degree and supervisory leadership are preferred.

Qualifications

• Must have strong supervisory and leadership capabilities.
• Experience with HMO/Managed Care operations is required.
• Proficiency in training staff and developing workflows.

Responsibilities

• Provide overall supervision to appeals and grievances operations.
• Ensure compliance with State and NCQA Appeals regulations.
• Develop and implement training programs and policies for staff.
• Create and adjust workflows to drive efficiency in the department.

Skills

Supervisory experience

Staff development

Training

Policy implementation

Education

Associate degree in business, health care or related field

High school diploma with two years of related experience

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
• Requisition ID: 26003413
• Daily Work Times: 8:30 am - 5:00 pm
• Hours Per Pay Period: 80
• On Call: No
• Weekends: No