Supervisor Grievance and Appeals

CalOptima Health Partnership; Orange (CA); On-site; USD 95,000 - 120,000; Full time

Benefits offered by this job

Partial Telework

Job summary

CalOptima Health Partnership is seeking a Supervisor for Grievance and Appeals to lead the daily operations of GARS, supervising staff and guiding training initiatives. You will work with the trainer, audit team, and analysts to identify patterns and streamline processes, while staying current on member benefits and regulatory changes to ensure compliance.

The role offers Partial Telework with required in-office presence in Orange, CA at least two days per week.

Responsibilities

• Supervise staff and provide training for GARS.
• Collaborate with trainer, audit team, and business analyst to identify trends and improve processes.
• Stay updated on member benefits and regulatory changes to ensure policy adherence.

Job description

Join Us in this Amazing Opportunity

More About the Opportunity

We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person.

We are hoping you will join us as a Supervisor Grievance and Appeals and help shape the future of healthcare where you’ll be an integral part of our GA - Provider Disputes team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to bePartial Telework.

• If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.

The Supervisor Grievance and Appeals will be responsible for the daily operations of Grievance and Appeals Resolution Services (GARS). You will supervise staff and provide the necessary training and guidance needed. You will work closely with the trainer, departmental audit team and business analyst to identify training opportunities, patterns and trends from the complaints and opportunities to streamline and improve processes. You will stay up to date on the latest information about CalOptima Health’s member benefits and regulatory changes and ensure adherence to established policies and procedures regarding the appeals and grievance process.Together, we are building a stronger, more equitable health system.

Your Contributions To the Team:

• 50% - Supervisory Functions
  • Participates