This position oversees the process of advocating for member rights within the organization, assuring grievance and appeal trends are reported to and addressed within the appropriate quality improvement committee(s). Provides supervision to the Grievance and Appeals (GAU) department and oversees the organization of work and work-flow so that performance standards and procedures for appeals resolution are consistent with client, state and federal requirements. He/she is responsible for the oversight of the grievance and appeals process across the company for providers and members as well as oversees the member complaint process. This position ensures all processes meet contractual and regulatory requirements across all lines of business. He/she is responsible for gathering and analyzing data related to the performance of the department and company and identifying process improvement opportunities. He/she is also responsible for monthly, quarterly and annual reporting as required by regulatory bodies.
Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.
Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at email@example.com.
Neighborhood is an EOE M/F/D/V and an E-Verify Employer