Manager, Customer Care Medicare Strategy

Job Summary:
The Manager, Grievance and Appeals is responsible for oversight of the Grievance, Appeal, IRE/IRO and State Hearing teams within CareSource.
Essential Functions:

Provide leadership and direction to staff to ensure the goals and standards of the department and CareSource are successfully achieved

Manage staff to ensure timely and accurate completion of tasks and issues are accomplished

Oversee and monitor processes to ensure department is meeting all regulatory requirements and accreditation standards

Oversee and ensure grievances and appeals are resolved and reported appropriately

Oversee, analyze and provide feedback to all areas that submit grievances and appeals

Develop, implement and execute grievances and appeals training to business areas as needed

Analyze and evaluate operations and identify process improvement

Identify irregular trends with grievances and appeals; work with other areas as appropriate to identify root causes and appropriate steps for resolution

Monitor trends and regulatory changes for impact to the department

Report data to appropriate committees with CareSource

Oversee, develop and execute the grievances and appeals process for new product lines

Review and interpret regulatory requirements and ensure business policies and processes are in compliance

Lead initiatives to track and trend grievances and appeals data in order to drive process improvements

Develop a culture of accountability and flexibility within the team to support the organizational mission and vision

Perform any other job duties as requested

Education and Experience:

Bachelor’s degree or equivalent years of relevant work experience is required

Prior experience in the healthcare industry is preferred

Minimum of three (3) years of management experience is preferred

Minimum of four (4) years of grievance and appeals experience is preferred

Competencies, Knowledge and Skills:

Proficient in Microsoft Office Suite to include Word, Excel and PowerPoint

Basic experience with ACD systems

Basic experience with Call Management Systems

Excellent written and verbal communication skills

Strong interpersonal skills, high level of professionalism and a collaborative management style

Effective problem solving skills with attention to detail

Effective listening and critical thinking skills

Ability to work independently and within a team environment

Ability to develop, prioritize and accomplish goals

Strategic management skills

Familiarity of the healthcare field with knowledge of Medicaid and Medicare

Ability to work in a fast-paced and constantly changing environment

Licensure and Certification:
None

Working Conditions:
General office environment; may be required to sit or stand for extended periods of time

Compensation Range:
$83,000.00 - $132,800.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
SalaryOrganization Level Competencies

Fostering a Collaborative Workplace Culture

Cultivate Partnerships

Develop Self and Others

Drive Execution

Influence Others

Pursue Personal Excellence

Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
Brand=CareSourceOriginally posted on Himalayas