Description
The Senior Manager Appeals and Grievances has direct responsibility for the design, implementation and ongoing operations of the Health Plan Grievances and Appeal process for California. This position directs and ensures the efficient operational management of health plan appeals and grievances with emphasis on patient and caregiver dignity, outcome performance and continual improvement. The senior manager is a leader of PSJH mission, vision, values and business needs as well as ensuring PSJH follows health plan regulations. The Senior Manager will work closely with each network Medical Director in using clinical knowledge, experience and licensures to support caregivers in the careful evaluation and prompt response to patient appeals of covered services and patient grievances.
Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Medical Foundation and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Required Qualifications:
- Bachelor's Degree in Nursing, Business or related field.
- Driving may be necessary as part of this role. Caregivers are required to comply with all state laws and requirements for driving. Caregivers will be expected to provide proof of driver license and auto insurance upon request.
- 7 years of related experience.
- The development, implementation, and management of Utilization Management, Risk and/or Quality Management Programs.
- 8 years of Leadership experience in an ambulatory or acute care setting.
- Strong project management and operations experience.
Preferred Qualifications:
- Master's Degree in Nursing, Business or related field.
- 5 years of Supervisory/management experience in an ambulatory or acute care setting.
- 7 years of Progressive leadership experience in the implementation and management of a Utilization Management, Risk and/or Quality Management Program including business development, strategic planning with ability to drive innovation and take educated risks.
Why Join Providence?
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
About Providence
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected.
About the Team
Providence Clinical Network (PCN) is a service line within Providence serving patients across seven states with quality, compassionate, coordinated care. Collectively, our medical groups and affiliate practices are the third largest group in the country with over 11,000 providers, 900 clinics and 30,000 caregivers.
Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.
Requisition ID: 321747
Company: Providence Jobs
Job Category: Administrative Support
Job Function: Administration
Job Schedule: Full time
Job Shift: Day
Career Track: Leadership
Department: 7520 QUALITY ASSURANCE CA HERITAGE SERVICES
Address: CA Anaheim 200 W Center St Promenade
Work Location: St Joseph Home Health-Anaheim
Workplace Type: On-site
Pay Range: $53.33 - $85.85
