Resource Manager driving operational excellence across EMEA for Croud, a global digital marketing agency. Ensuring effective resource management and team wellbeing through data - driven decision making.
About the role
- Manager for Grievance & Appeals at Centene overseeing member complaints and regulatory compliance. Requires operational experience and strong leadership skills in a healthcare environment.
Responsibilities
- Ensure appropriate processing of member grievance appeals, provider appeals, or request for a State Fair Hearing
- Perform duties as the point of contact with the State
- Manage the day to day responsibilities of the Grievance & Appeals Coordinators
- Ensure that the Grievance and Appeals department processes all appeals and grievances in accordance with referred time frames and other contractual legal requirements
- Monitor appeals and grievances and provide senior management with monthly reporting on trends
- Ensure that all members and provider grievances are processed and investigated according to contract requirements
- Work with various external constituencies, i.e., state, local and federal governments, local community and the public related to grievance and appeals
- Integrate federal and state law changes into company’s regulatory system related to grievance and appeals
- Recommend solutions and works with department and company staff to ensure problems are corrected and departments are advised of corrective measures to prevent recurrences
- May provide training and direction to agencies in developing procedures to comply with grievance and appeals requirements
- Review and process incoming incident/accident reports
Requirements
- Bachelor’s degree in related field or equivalent experience
- 3+ plus years of experience in healthcare/law, grievances and appeals
- Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
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Resource Manager driving operational excellence across the EMEA agency for a digital marketing firm. Ensuring resource levels are appropriate and optimizing resource management strategies for client needs.
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