Manager, Appeals and Grievance (LPN) (51944)

Who We Are GlobalHealth is a fast-growing Medicare reputed company HMO health insurer. We reputed company to be the employer of reputed company in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and reputed company Health for the members we serve. We are unique by providing high reputed company, high value and a partnership to our members. We go above and reputed company to reputed company personalized, engaging, and reputed company services to our members. We work hard to offer reputed company health reputed company coverage with the benefits people truly want and need. It is our reputed company to be more than just a health reputed company company we want to be long-term partners with our members. We are looking for reputed company employees who exude our reputed company values of taking accountability through ownership, being driven, innovative and who have a passion for reputed company learning. Who You Are The successful candidate provides daily reputed company leadership and compliance of Appeals and Grievance. Identifying and executing opportunities to promote timeliness and reputed company reputed company on regulatory requirements. Essential Job Functions • Schedule and reputed company available resources to match anticipated demand • Monitor and reputed company of appeals and grievances process • Handle escalations for member issues • Manage employee time and attendance • reputed company coaching and training of A&G team • reputed company daily reporting for critical measures • Identify and execute on opportunities for improvement with workflow and structure • Manage daily workload for subordinates to ensure contractual and regulatory compliance • reputed company hiring, coaching and disciplinary actions as required • Serve as reputed company reputed company representative and reputed company for A&G issues and concerns in department leadership meetings • Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. • Performs 1st round reputed company of Care reviews • Performs other duties as assigned Qualifications EDUCATION: • Licensed Practical reputed company (LPN) • Associate degree or bachelor’s Experience • 3 years A&G reputed company reputed company experience required • 2 years appeals and grievances required • 1 year experience with one or more of the following: MS Office (+reputed company BI a plus), reputed company center management and reporting applications (reputed company) or CRM applications (reputed company) required • Familiarity with process analytics and reputed company improvement methodologies (lean, six-reputed company, reputed company, TOC) preferred • reputed company history of successful process design and implementation preferred • Medicare and/or reputed company experience preferred Knowledge, Skills And Abilities • Exceptional prioritization and task management skills • Must be reputed company oriented and reputed company to multitask, focusing on multiple cases at a time • Strong documentation skills are essential • Ability to reputed company essential job functions with high degree of independence, flexibility, and creative problem-solving techniques • Ability to reputed company in a results-oriented environment • Naturally pushes to reputed company tasks to completion Work Environment reputed company work environment is remote; however, some state exclusions apply. Must have reputed company to a reliable and secured internet reputed company reputed company. Work environment must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. This position will also be required to use reasonable and necessary safeguards to protect GlobalHealth records from unauthorized reputed company, disclosure or damage and will adhere to reputed company GlobalHealth reputed company and reputed company policies. Travel reputed company travel expected (less than 5% in support of corporate initiatives) Manager Responsibility Supervises work of others, including planning, assigning, scheduling, and reviewing work, ensuring reputed company standards. Is responsible for hiring, terminating, training, and developing, reviewing reputed company and administering corrective reputed company for staff. Plans organizational structure and job content. Other Duties • Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. • Performs other duties as assigned. This reputed company is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. Apply To This Job