Directeur d'expérience en certification at Demers Beaulne overseeing audit strategies and managing team performance in a hybrid setting with professional development opportunities.
About the role
- Senior Director managing grievance and appeals for L.A. Care Health Plan. Overseeing operations and regulatory compliance for healthcare services in Los Angeles.
Responsibilities
- Direct oversight of L.A. Care’s grievance, appeal, and State Fair Hearing functions
- Ensure all cases are processed accurately and consistently with exceptional quality
- Develops strategic plans and drives change
- Collaborate extensively with cross-functional key stakeholders
- Strengthen preventive controls and improve service delivery
- Fosters a culture of proactive issue identification and operational improvement
Requirements
- Bachelor's Degree
- At least 9 years of experience in health plan operations, managed care, A&G, utilization management, clinical operations, or regulatory compliance
- At least 8 years of leading staff, supervisor/management experience
- Extensive leadership experience in Medicaid, Medicare, and Commercial managed care lines of business
- Experience navigating regulatory and accreditation requirements
- Strong track record of applying complex regulatory standards to grievance, appeal, and quality-of-care operations
- Experience leading organizations through high-stakes regulatory audits
- Preferred: Registered Nurse (RN) - Active, current and unrestricted California License
Benefits
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
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