Manager, Grievance and Appeals Service Integration

Job Summary:

The Manager, Grievance and Appeals Service Integration is responsible for driving strategic integration of regulatory, operational, and technical initiatives within the Grievance and Appeals function. This role supports the implementation of new business markets, accreditation readiness, and systemic process improvement through project leadership, data analytics, and cross-functional collaboration.

Essential Functions:

• Lead the development of new business market implementations for technical and non-technical projects required to become compliant with new regulations/accreditation standards, enhance efficiency, and improve departmental and corporate processes
• Provide project management and leadership for implementation of CareSource operational changes, business offerings, and IT Solutions
• Oversee and complete project management activities including project scope, charter, deliverables, resources, timeline, budget, staffing, billing milestones and leadership expectation management
• Complete project management tasks such as agenda development, production and distribution of meeting minutes, and documents and preparation of reports on project status and activities to various stakeholders
• Lead teams to analyze current workflow processes related to Grievance and Appeals operations and properly diagnose key problems and implement improvement opportunities
• Communicate regularly with stakeholders about team progress toward goal achievement, critical factors, and obstacles
• Collaborate with team to adjust and eventually seek consensus on newly designed workflows in a timely manner
• Support readiness activities for new markets and regulatory initiatives by facilitating virtual and onsite readiness reviews and audits, preparing executive-level presentations, and project updates for leadership and compliance stakeholders.
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s degree in Business, IT or Healthcare Administration or equivalent years of experience required
• Master’s degree preferred
• A minimum of three (3) years of project management, application implementation and/or deployment projects is required
• A minimum of two (2) years of previous leadership experience is required
• Experience with operational process improvement projects preferred
• Technical writing experience preferred

Competencies, Knowledge and Skills:

• Familiarity of the healthcare field with knowledge of Medicaid, Marketplace, and Medicare
• Advanced knowledge of Microsoft Word, Excel, PowerPoint and Visio
• Strong motivational skills
• Knowledge of Grievance and Appeals operations and trends
• Strong collaboration and conflict resolution skill sets
• Proven leadership with the ability to build relationships, collaborate and influence at all levels
• Ability to work in a fast-past environment
• Ability to prioritize varied tasks within multiple assignments and analyze workflow to recommend improved processes
• Exceptional written and verbal communication skills
• Ability to work independently and within a team environment
• Effective active listening and critical thinking skills

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Ability to travel as required by the needs of the business

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.