Description
General Summary of Position
Looking for an opportunity to have a positive impact on the lives of the underserved communities in DC and throughout Maryland? As the Manager of Grievances and Appeals, you'll have the opportunity to provide strategic leadership that shapes the experience of the individuals and families served within MedStar Family Choice.
Join a team that values innovative and person-centered services that empowers the people we serve to live their best lives.
At MedStar Family Choice, we envision a world where people in need of healthcare and social services, learn, work, play, and have meaningful relationships in our communities.
In realizing our vision, we provide innovative and person-centered services, support and information that empowers the people we serve to live their best lives in our culturally diverse community.
Some of the values that guide our staff's work every day include:
Listening and engaging without judgement and collaborating effectively with people of diverse backgrounds and cultures.
Focusing on outcomes to ensure the people we serve live their best lives.
Providing timely, accurate, and comprehensive information to our community.
Recognizing and respecting everyone's unique strengths, gifts, talents, skills, and contributions.
Apply now to join our team!
Responsible for day-to-day oversight and management of Intake, Clinical Appeals, Claims Appeals, Complaints, Grievances and Intake functions. The Manager of Appeals, Complaints and Grievances will be dedicated to delivering service and operational excellence through a focus on continuous improvement in the areas of contribution, competencies, and performance of the Intake, Appeals, Complaints and Grievances team. This role will be tasked with overseeing intake, the development and operational execution of all appeals (clinical and non-clinical), complaints and grievance processes in line with regulatory standards while enhancing quality and effectiveness. Additionally, the role will need to utilize advanced technical knowledge to resolve complex issues. This involves setting objectives, creating policies and procedures, determining approaches, allocating resources and managing inventory.
Requirements:
* Bachelor's in nursing Required
* DC and MD or Compact RN License Required
* 3-5 years' experience in Utilization Management in a Managed Care Organization (MCO) Required
* 5-7 Years diverse clinical experience in a hospital or medical setting Required
* 1-2 years Nursing Supervisory experience Required
* 1-2 years' experience in grievances and appeals with expert knowledge in Medicaid Required
Primary Duties and Responsibilities
Minimum Qualifications
Education
- Bachelor's degree in Nursing required
Experience
- 3-4 years Utilization management experience required and
- 5-7 years Diverse clinical experience in a hospital or medical setting required and
- 1-2 years 2 years supervisory experience required
- Additional experience with appeals and grievances preferred
Licenses and Certifications
- RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the State of Maryland upon hire and valid RN licensure in the District of Columbia (DC) prior to start date in position. Upon Hire required and
- CCM - Certified Case Manager Active Certified Case Manager (CCM) or CCM certification within 1 Year required
Knowledge, Skills, and Abilities
- Excellent verbal and written communication skills.
- Proficient in Microsoft Word, Excel, and PowerPoint.
This position has a hiring range of $100,588 - $190,340
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