Manager, Customer Care Medicare Strategy

CareSource Management Services LLC is hiring a Manager, Grievance and Appeals to oversee its Grievance, Appeal, IRE/IRO and State Hearing teams. The role leads staff and ensures grievances and appeals are handled in compliance with regulatory requirements, while using reporting, trend analysis and process improvement to support department performance.

Responsibilities:

• 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

Requirements:

• Bachelor's degree or equivalent years of relevant work experience
• 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
• Prior experience in the healthcare industry
• Minimum of three (3) years of management experience
• Minimum of four (4) years of grievance and appeals experience