Manager, Grievance & Appeals

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

📋 Description

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

• Act as the primary liaison with the State.

• Oversee the daily operations of Grievance & Appeals Coordinators.

• Guarantee that appeals and grievances are managed within mandated timelines and contractual legal obligations.

• Track appeals and grievances while delivering monthly trend reports to senior management.

• Ensure the processing and investigation of member and provider grievances aligns with contract stipulations.

• Collaborate with state, local, and federal authorities, as well as 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 resolve issues and prevent future occurrences.

• Provide training and guidance to agencies in the development of compliant procedures.

• Review and process incoming incident and accident reports.

⛳️ Requirements

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

• 3+ years of experience in healthcare/law, focusing on grievances and appeals.

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

• Supervisory experience, including hiring, training, assigning tasks, and managing staff performance.

• Strongly preferred: residency in Oregon.

• Strongly preferred: active RN licensure in Oregon.

• Availability aligned with Pacific Standard Time (PST).

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K and stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• A flexible approach to work, offering remote, hybrid, field, or office work schedules.

• Additional forms of incentives may be included in total compensation.

• Equal opportunity employer committed to diversity.