Grievance & Appeals Supervisor Job

GRIEVANCE & APPEALS SUPERVISOR needed for a CONTRACT opportunity with Yoh's client located in Los Angeles, CA.

Top Skills Should You Possess:
- Medicare/Medi-Cal experience
- Registered Nurse

What You'll Be Doing:
- Serve as the supervisor of the Grievance and Appeals team
- Monitor the timeline for handling member grievances and provider appeals
- Ensure that all grievances are sent to the correct department for resolution
- Will handle all State Fair Hearings (SFH) expeditiously and resolved to member satisfaction
- Work with the team to handle Medicare, Medi-Cal, Healthy Families, Healthy Kids complaints
- Represents the unit and department internally for quarterly audits
- Interact with external regulators and internal departments regarding issues directed to members

What You Need to Bring to the Table:
- Registered Nursing license in the state of California
- Bachelor's degree in Nursing (BSN) or a BA degree in health care related field preferred
- Five (5) plus years of supervisory or lead position experience
- Six (6) plus years of client/member advocacy experience
- Medi-Cal screening/eligibility experience
- Strong experience with Grievance and Appeals
- Proficient use of Microsoft Word, Excel, Access
- Bilingual English/Spanish
- Strong communication and customer service skills

OPPORTUNITY IS CALLING, APPLY NOW!

RECRUITER: Emi Flaherty

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V. Click here to contact us if you are an individual with a disability and require accommodation in the application process.

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