Weekend Appeals & Grievances Inventory Lead

Healthfirst; Town of Texas (WI); On-site; USD 89,000 - 132,000; Full time

Job summary

Healthfirst is seeking an Appeals & Grievances Weekend Inventory Manager to oversee weekend appeal inventory for a team of Clinical Specialists. This full-time role requires working 4 days weekly, Fri-Mon or Thurs-Sun, coordinating with leaders to ensure high‑quality, compliant output.

You will optimize routing, manage vendor performance, and support escalation with Medical Peer reviewers while maintaining HIPAA confidentiality and cross‑department collaboration.

Qualifications

• High school diploma or GED required with healthcare environment experience preferred.
• Bachelor's degree is preferred and RN/LPN is a plus.
• Experience handling appeals/grievances or similar healthcare processes.
• Ability to work independently in a fast-paced weekend schedule.

Responsibilities

• Plan weekend staff assignments and volumes to ensure compliance.
• Triage and assign expedited appeals; optimize routing.
• Manage inventory and regulatory compliance for weekend appeals.
• Coordinate with Medical Peer reviewers and vendor relationships.
• Escalate cases and coordinate with other departments for resolution.
• Oversee letter review, printing, and mailroom coordination.
• Review change requests, submit Level 2 appeals packets.
• Monitor industry trends and implement improvements.

Skills

Verbal communication

Written communication

Multi-tasking

Weekend availability

Education

High School Diploma or GED

Bachelor's degree

Tools

Microsoft Word

Microsoft Excel

Email/CRM tools

CCMS / TruCare / Hyland

Job description

Healthfirst is seeking an Appeals & Grievances Weekend Inventory Manager to oversee weekend appeal inventory for a team of Clinical Specialists. This full-time role requires working 4 days weekly, Fri-Mon or Thurs-Sun, coordinating with leaders to ensure high‑quality, compliant output.

You will optimize routing, manage vendor performance, and support escalation with Medical Peer reviewers while maintaining HIPAA confidentiality and cross‑department collaboration.