Medicare Advantage Appeals and Grievances Manager

Description Take on a key leadership role within an award-winning health system. Help improve patient experiences as part of a world-class healthcare team. Take your career in an exciting new direction. You can do all this and more at UCLA Health.
As an important member of our Medicare Advantage team, you will implement and execute organizational and operational strategies related to member and provider appeals and grievances while managing the day-to-day operations of the Appeals and Grievance department. You will oversee the accurate, compliant, efficient, and timely response to member and provider appeals and grievances. The role involves partnering with internal information systems and operations teams, and external vendors to ensure end-to-end appeals and grievance processing and reporting capabilities are established in adherence to all regulatory requirements and UCLA Health contract provisions. You will establish departmental goals and objectives and manage the accountability and stewardship of human and financial resources.
Salary Range: $67,400 - $133,400 Annually

Qualifications We're seeking a self-motivated, flexible, goal-driven, service-oriented leader with:
* Bachelor's degree in business administration, healthcare, or a related field equivalent 10 years of work experience preferred
o Minimum 5 years' experience in a Manager role
o 5+ years' experience working in appeals (including medical and pharmacy).
o 5+ years' experience in investigating, and responding to appeals and grievances.
o 5+ years' experience managing a A&G department in a health plan
* Excellent critical thinking, analytical, troubleshooting, problem-resolution, and process-improvement skills
* Strong management, communication, interpersonal, organizational, and presentation abilities
* Computer proficiency with Microsoft Office and data visualization tools
* Knowledge of medical terminology and Medicare/CA DMHC state regulations.
* In-depth knowledge of Medicare Managed Care organization determination, appeals, and grievance requirements
* Experience supervising employees, developing performance standards, coaching, training, conducting performance reviews, and making personnel decisions
* Ability to lead and facilitate cross-functional workgroups
* Expertise in working with complex organizations to comply with regulatory requirements
UCLA Health is a world-renowned health system with four award-winning hospitals and more than 260 community clinics throughout Southern California. We're also home to the world-class medical research and clinical education capabilities of the David Geffen School of Medicine. Through the efforts of our outstanding people, we have become Los Angeles' trusted provider of exceptional, compassionate patient care. If you're looking to experience greater challenge and fulfillment in your career, you can at UCLA Health.