Manager, Grievance & Appeals

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Oversee the proper handling of member grievance appeals, provider appeals, and requests for a State Fair Hearing.

• Act as the primary liaison with the State.

• Supervise the daily operations of Grievance & Appeals Coordinators.

• Ensure that the department processes appeals and grievances within specified time frames and adheres to contractual and legal obligations.

• Track appeals and grievances and furnish senior management with monthly trend reports.

• Guarantee that member and provider grievances are processed and investigated in accordance with contract stipulations.

• Collaborate with state, local, and federal governments, local communities, and the public regarding grievance and appeals issues.

• Incorporate changes in federal and state laws into the company's regulatory framework.

• Propose solutions and collaborate with departmental and company personnel to address issues and prevent future occurrences.

• Provide training and guidance to agencies developing compliant procedures.

• Evaluate and process incoming incident and accident reports.

⛳️ Requirements

• Candidates must reside in Arizona.

• Bachelor’s degree in a relevant field or equivalent experience.

• A minimum of 3 years of experience in healthcare/law, grievances, and appeals.

• Prior experience in a leadership role within a functional area, overseeing cross-functional teams on large-scale projects, or supervisory experience.

• Supervisory experience including hiring, training, assigning work, and managing employee performance.

• Capability to process grievances, appeals, State Fair Hearing requests, and incident/accident reports in compliance with contractual and legal standards.

• Familiarity with federal and state laws pertaining to grievances and appeals.

• Ability to engage with state, local, and federal governments, local communities, and the public.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement program.

• Paid time off along with holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional incentive forms may be included in the overall compensation package.

• Benefits may vary based on program eligibility.