Elevance Health
Manager II Grievances and Appeals (RN)-CA
Elevance Health, Palo Alto, California, United States, 94306
Anticipated End Date:
2024-11-19 Position Title:
Manager II Grievances and Appeals (RN)-CA Job Description: Manager II Grievance/Appeals (RN)-California Location:
This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our California Elevance Health PulsePoint locations listed below: Woodland Hills Costa Mesa Palo Alto Walnut Creek The
Manager II Grievance/Appeals
is responsible for management oversight of grievances and appeals departmental units to investigate, resolve, and respond to grievances and appeals, manage inventory and production levels, and operational and plan risk, ensure quality, and regulatory compliance. How you will make an impact: Primary duties may include, but are not limited to: Coordinates Grievance and Appeals Committee Meetings and Member Panel Hearings. Leads grievance and appeals in regulated audits. Serves as a resource for complex issues and interpretation of claims, provider contracts and data, eligibility, member contracts, benefits, clinical decisions, pharmacy on pre-service and post-service appeals and grievances related to non-clinical and clinical services, quality of service and quality of care issues including executive and regulatory grievances. Oversees and implements new subsystems, procedures, techniques and supports digital automation objectives. Analyzes and develops strategies by achieving performance thresholds within budgetary guidelines. Monitors trends and analyzes grievance and appeals data to identify and recommend plan and policy changes and to ensure state and federal regulatory compliance and resolution within the regulatory timeframes. 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: Bachelor’s degree and 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: Active unrestricted RN license (California) 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. For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $95,128 to $148,896. In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact
elevancehealthjobssupport@elevancehealth.com
for assistance.
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2024-11-19 Position Title:
Manager II Grievances and Appeals (RN)-CA Job Description: Manager II Grievance/Appeals (RN)-California Location:
This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our California Elevance Health PulsePoint locations listed below: Woodland Hills Costa Mesa Palo Alto Walnut Creek The
Manager II Grievance/Appeals
is responsible for management oversight of grievances and appeals departmental units to investigate, resolve, and respond to grievances and appeals, manage inventory and production levels, and operational and plan risk, ensure quality, and regulatory compliance. How you will make an impact: Primary duties may include, but are not limited to: Coordinates Grievance and Appeals Committee Meetings and Member Panel Hearings. Leads grievance and appeals in regulated audits. Serves as a resource for complex issues and interpretation of claims, provider contracts and data, eligibility, member contracts, benefits, clinical decisions, pharmacy on pre-service and post-service appeals and grievances related to non-clinical and clinical services, quality of service and quality of care issues including executive and regulatory grievances. Oversees and implements new subsystems, procedures, techniques and supports digital automation objectives. Analyzes and develops strategies by achieving performance thresholds within budgetary guidelines. Monitors trends and analyzes grievance and appeals data to identify and recommend plan and policy changes and to ensure state and federal regulatory compliance and resolution within the regulatory timeframes. 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: Bachelor’s degree and 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: Active unrestricted RN license (California) 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. For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $95,128 to $148,896. In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact
elevancehealthjobssupport@elevancehealth.com
for assistance.
#J-18808-Ljbffr