Senior Manager Appeals and Grievances - QUALITY ASSURANCE at Providence Health & Services
Anaheim, CA 92801
About the Job
The Senior Manager Appeals and Grievances has direct responsibility for the design, implementation and ongoing operations of the Health Plan Grievances and Appeal process for California
This position directs and ensures the efficient operational management of health plan appeals and grievances with emphasis on patient and caregiver dignity, outcome performance and continual improvement
The senior manager is a leader of PSJH mission, vision, values and business needs as well as ensuring PSJH follows health plan regulations
The Senior Manager will work closely with each network Medical Director in using clinical knowledge, experience and licensures to support caregivers in the careful evaluation and prompt response to patient appeals of covered services and patient grievances.Providence caregivers are not simply valued – they’re invaluable
Join our team at Providence Medical Foundation and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect
Your voice matters here, because we know that to inspire and retain the best people, we must empower them.Required Qualifications: Bachelor's Degree in Nursing, Business or related field.Driving may be necessary as part of this role
Caregivers are required to comply with all state laws and requirements for driving
Caregivers will be expected to provide proof of driver license and auto insurance upon request. 7 years of related experience. The development, implementation, and management of Utilization Management, Risk and/or Quality Management Programs.8 years of Leadership experience in an ambulatory or acute care setting.Strong project management and operations experience.Preferred Qualifications:Master's Degree in Nursing, Business or related field.5 years of Supervisory/management experience in an ambulatory or acute care setting.7 years of Progressive leadership experience in the implementation and management of a Utilization Management, Risk and/or Quality Management Program including business development, strategic planning with ability to drive innovation and take educated risks.Why Join Providence?Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security
We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others
We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected
Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington
As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more
Learn more at providence.jobs/benefits.Providence Clinical Network (PCN) is a service line within Providence serving patients across seven states with quality, compassionate, coordinated care
Collectively, our medical groups and affiliate practices are the third largest group in the country with over 11,000 providers, 900 clinics and 30,000 caregivers
PCN is comprised of Providence Medical Group in Alaska, Washington, Montana and Oregon; Swedish Medical Group in Washington’s greater Puget Sound area, Pacific Medical Centers in western Washington; Kadlec in southeast Washington; Providence’s St
John’s Medical Foundation in Southern California; Providence Medical Institute in Southern California; Providence Facey Medical Foundation in Southern California; Providence Medical Foundation in Northern and Southern California; and Covenant Medical Group and Covenant Health Partners in west Texas and eastern New Mexico.Providence is proud to be an Equal Opportunity Employer
We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law
We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.Full timePosting Date: 2024-10-21
This position directs and ensures the efficient operational management of health plan appeals and grievances with emphasis on patient and caregiver dignity, outcome performance and continual improvement
The senior manager is a leader of PSJH mission, vision, values and business needs as well as ensuring PSJH follows health plan regulations
The Senior Manager will work closely with each network Medical Director in using clinical knowledge, experience and licensures to support caregivers in the careful evaluation and prompt response to patient appeals of covered services and patient grievances.Providence caregivers are not simply valued – they’re invaluable
Join our team at Providence Medical Foundation and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect
Your voice matters here, because we know that to inspire and retain the best people, we must empower them.Required Qualifications: Bachelor's Degree in Nursing, Business or related field.Driving may be necessary as part of this role
Caregivers are required to comply with all state laws and requirements for driving
Caregivers will be expected to provide proof of driver license and auto insurance upon request. 7 years of related experience. The development, implementation, and management of Utilization Management, Risk and/or Quality Management Programs.8 years of Leadership experience in an ambulatory or acute care setting.Strong project management and operations experience.Preferred Qualifications:Master's Degree in Nursing, Business or related field.5 years of Supervisory/management experience in an ambulatory or acute care setting.7 years of Progressive leadership experience in the implementation and management of a Utilization Management, Risk and/or Quality Management Program including business development, strategic planning with ability to drive innovation and take educated risks.Why Join Providence?Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security
We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others
We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected
Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington
As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more
Learn more at providence.jobs/benefits.Providence Clinical Network (PCN) is a service line within Providence serving patients across seven states with quality, compassionate, coordinated care
Collectively, our medical groups and affiliate practices are the third largest group in the country with over 11,000 providers, 900 clinics and 30,000 caregivers
PCN is comprised of Providence Medical Group in Alaska, Washington, Montana and Oregon; Swedish Medical Group in Washington’s greater Puget Sound area, Pacific Medical Centers in western Washington; Kadlec in southeast Washington; Providence’s St
John’s Medical Foundation in Southern California; Providence Medical Institute in Southern California; Providence Facey Medical Foundation in Southern California; Providence Medical Foundation in Northern and Southern California; and Covenant Medical Group and Covenant Health Partners in west Texas and eastern New Mexico.Providence is proud to be an Equal Opportunity Employer
We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law
We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.Full timePosting Date: 2024-10-21
