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Manager ll Grievance/Appeals

Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

The Manager ll Grievance/Appeals is responsible for management oversight of grievances and appeals departmental units to investigate, resolve, and respond to client/provider grievances/appeals and ensure compliance with regulatory requirements.

How you will make an impact:

• Maintains and coordinates staff activities to achieve departmental and corporate goals to improve service to customers/providers and assures regulatory compliance.

• Analyzes and develops strategies by achieving performance thresholds within budgetary guidelines.

• Addresses both internal/external customer/provider needs and concerns related to team activities.

• Ensures programs support overall QI program and meet regulatory compliance/accreditation and the company standards.

• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Minimum Requirements:

Requires a minimum of 5+ years grievance & appeals experience and a minimum of 3 years of management experience in the healthcare industry; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• BA/BS preferred.

• Part D and/or Part C Appeals experience preferred.

• Part D and/or Part D CD or OD experience preferred.

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.