Mgr Clinical Appeals and Grievances

Job description

The Manager, Clinical Appeals & Grievances is responsible for leading, operating, and advising a dynamic and fast-paced Clinical Appeals & Grievances team. This role works closely with multiple leaders in the organization to identify priority focus areas for Appeals & Grievances, to standardize and optimize processes, and to communicate performance to multiple stakeholders. In tandem with these efforts, this individual will oversee internal and external production teams to ensure consistent production, high quality and to maintain compliance on all levels. This role will remain flexible while utilizing strategic thinking and creativity to address challenges in alignment with long term growth and profitability goals of Healthfirst. Duties and Responsibilities: - Manages a team of specialists, with responsibility for goal and productivity management, coaching and counseling, performance management and other leadership responsibilities as assigned - Provides oversight in case research and provides advice as needed - Understands HF’s internal health plans’ policies and procedures to frame decisions - Interprets regulations to provide guidance to specialists on a daily basis - Ensures t...