Hybrid Senior Director, Grievance Officer – Appeals and Grievances

at L.A. Care Health Plan

• Job title: Senior Director, Grievance Officer – Appeals and Grievances
• Job type: Full Time
• Experience level: Senior
• Salary: $171,925 - $292,274 per year
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, Los Angeles, United States

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)