Manager, Appeals & Grievances

Welcome to Molina Healthcare! We are currently seeking a highly motivated and experienced Manager to join our team as the Manager of Appeals & Grievances. In this role, you will be responsible for overseeing the appeals and grievances process to ensure timely, accurate, and compliant resolution of member and provider concerns. We are looking for a candidate who is passionate about providing exceptional customer service and has a strong understanding of healthcare regulations. If you are a driven individual with excellent leadership skills and a dedication to improving healthcare outcomes, we encourage you to apply for this exciting opportunity.

1. Oversee the appeals and grievances process: The Manager of Appeals & Grievances will be responsible for managing and supervising the appeals and grievances process. This includes reviewing and resolving member and provider complaints, ensuring compliance with regulations and company policies, and providing training and guidance to staff.
2. Ensure timely and accurate resolution: The Manager will be expected to ensure that all appeals and grievances are handled in a timely and accurate manner. This includes monitoring case progress, conducting quality assurance checks, and implementing process improvements to increase efficiency and effectiveness.
3. Maintain compliance: Compliance is crucial in the healthcare industry, and the Manager will play a key role in ensuring that all appeals and grievances are handled in accordance with regulatory requirements and company policies. This includes staying up-to-date on industry changes and implementing necessary updates to processes and procedures.
4. Provide exceptional customer service: Molina Healthcare prides itself on providing exceptional customer service to its members and providers. The Manager will be responsible for setting and maintaining high standards of customer service within the appeals and grievances department, and ensuring that all staff members are trained and equipped to deliver exceptional service.
5. Lead and develop a team: The Manager will be responsible for managing a team of appeals and grievances staff members. This includes hiring, training, and evaluating staff performance, as well as fostering a positive and collaborative work environment.
6. Collaborate with other departments: The Manager will work closely with other departments within Molina Healthcare, such as Legal, Compliance, and Member Services, to ensure a seamless and efficient appeals and grievances process. Strong communication and collaboration skills are essential for success in this role.
7. Analyze and report on data: The Manager will be responsible for analyzing data related to appeals and grievances, identifying trends and areas for improvement, and reporting this information to senior management. This will help drive decision-making and improve overall processes and outcomes.
8. Stay informed on industry developments: To excel in this role, the Manager must stay informed on industry developments

According to JobzMall, the average salary range for a Manager, Appeals & Grievances in Albuquerque, NM, USA is $68,000-$92,000 per year. This can vary based on factors such as experience, education, and specific job responsibilities.

Molina Healthcare is a managed care company headquartered in Long Beach, California, United States. The company provides health insurance to individuals through government programs such as Medicaid and Medicare.