Current jobs related to Manager, Grievance - Woodland Hills, California - California Health & Wellness
-
Operations Manager
7 days ago
Woodland Hills, California, United States Blue Shield Of California Full time{"title": "Operations Manager", "content": "Job SummaryBlue Shield of California is seeking an experienced Operations Manager to join our Appeals and Grievances team. As a key member of our leadership team, you will be responsible for leading a team of professionals in resolving member concerns through a regulated process.Key ResponsibilitiesLead a team of...
-
Operations Manager
5 days ago
Woodland Hills, California, United States Blue Shield of California Full timeAbout the RoleThe Appeals and Grievances team at Blue Shield of California is seeking a highly skilled and experienced Operations Manager to join our team. As a key member of our leadership team, you will be responsible for providing strategic direction and oversight to our operations, ensuring that we deliver high-quality services to our members.Key...
-
Care Manager
2 weeks ago
Woodland Hills, California, United States Blue Shield of California Full timeAbout the RoleWe are seeking a highly skilled Care Manager to join our team at Blue Shield of California. As a key member of our Population Health Management Medi-Cal Team, you will play a critical role in supporting the mission of our department to provide high-quality care to our patients.Key ResponsibilitiesDevelop and Implement Care Plans: Research and...
-
Operations Director
1 week ago
Woodland Hills, California, United States Blue Shield of California Full time{"h1": "Operations Manager Role at Blue Shield of California", "p": "As a key member of our Appeals and Grievances team, you will play a critical role in resolving member concerns through a regulated process. Your expertise will ensure accurate, timely, and compliant addressing of each concern. You will report to the Senior Director of Operations and provide...
-
Operations Manager
1 week ago
El Dorado Hills, California, United States Blue Shield Of California Full timeAbout the RoleBlue Shield of California is seeking a highly skilled and experienced Operations Manager to join our Appeals and Grievances team. As a key member of our leadership team, you will be responsible for leading a team of professionals in resolving member concerns through a regulated process.Key ResponsibilitiesLead a team of professionals in...
-
Operations Manager
1 week ago
El Dorado Hills, California, United States Blue Shield Of California Full time{"title": "Operations Manager", "content": "Job SummaryBlue Shield of California is seeking an experienced Operations Manager to join our Appeals and Grievances team. In this role, you will be responsible for leading a team of professionals in resolving member concerns through a regulated process.Key ResponsibilitiesLead a team of professionals in resolving...
-
Operations Manager
7 days ago
El Dorado Hills, California, United States Blue Shield of California Full timeAbout the RoleWe are seeking a highly skilled and experienced Operations Manager to join our team at Blue Shield of California. As a key member of our Appeals and Grievances team, you will play a critical role in resolving member concerns through a regulated process.Key ResponsibilitiesLead a team of professionals in planning, cost management, and methods to...
-
Operations Manager
3 weeks ago
El Dorado Hills, California, United States Blue Shield of California Full timeJob SummaryBlue Shield of California is seeking a highly skilled Business Operations Lead to join our team. As a key member of our Appeals and Grievances team, you will be responsible for resolving member concerns through a regulated process.About the RoleProvide leadership and support to your team, interacting with members and specialty clients.Develop and...
-
Operations Manager
2 weeks ago
El Dorado Hills, California, United States Blue Shield Of California Full timeAbout the RoleThe Manager of Operations will play a crucial role in leading the Appeals and Grievances team at Blue Shield of California. This team is responsible for resolving member concerns through a regulated process, ensuring accurate, timely, and compliant responses to each concern.The successful candidate will report to the Senior Manager of...
-
Operations Manager
3 weeks ago
El Dorado Hills, California, United States Blue Shield Of California Full timeJob SummaryBlue Shield of California is seeking a highly skilled Manager of Operations to join our Appeals and Grievances team. As a key member of our leadership team, you will be responsible for resolving member concerns through a regulated process, ensuring accurate, timely, and compliant responses.Key ResponsibilitiesProvide leadership and support to your...
-
Manager of Operational Excellence
3 weeks ago
El Dorado Hills, California, United States Blue Shield of California Full timeJob SummaryBlue Shield of California is seeking a highly skilled Manager of Operations to lead our Appeals and Grievances team. As a key member of our organization, you will be responsible for resolving member concerns through a regulated process.About the RoleProvide leadership and support to your team, interacting with members and specialty clients.Develop...
-
Manager of Operations and Strategy
3 weeks ago
El Dorado Hills, California, United States Blue Shield Of California Full timeJob SummaryBlue Shield of California is seeking a highly skilled Manager of Operations to join our Appeals and Grievances team. As a key member of our leadership team, you will be responsible for resolving member concerns through a regulated process, ensuring accurate, timely, and compliant responses.Key ResponsibilitiesProvide leadership and support to your...
-
Senior Operations Manager
3 weeks ago
El Dorado Hills, California, United States Blue Shield Of California Full timeYour RoleThe Appeals and Grievances division is dedicated to addressing our members' concerns through a structured process that ensures each issue is handled accurately, promptly, and in compliance with regulations. The Senior Operations Manager will report directly to the Senior Director of Operations. In this capacity, you will lead and support your team...
-
Operations Manager
2 weeks ago
El Dorado Hills, California, United States Blue Shield Of California Full timeAbout the RoleThe Manager of Operations will report to the Senior Manager of Operations and be responsible for leading a team in resolving member concerns through a regulated process. This includes accurately, timely, and compliantly addressing each concern. The successful candidate will provide leadership and support to their team, interact with members and...
-
IT Operations Leadership Manager
3 weeks ago
Woodland, California, United States Sakata Seed America, Inc. Full timePOSITION SUMMARY:This role is responsible for overseeing the various personnel and functions within the IT department, specifically managing the operations of Sakata's SAH IT Operations.SUPERVISORY RESPONSIBILITIES:Direct supervision of Infrastructure personnel within the IT team under the Corporate Services division.- This includes system analysts,...
-
Operations Supervisor
3 weeks ago
El Dorado Hills, California, United States Blue Shield of California Full timeAbout the RoleThe Commercial Appeals & Grievances department at Blue Shield of California performs comprehensive research related to the facts and circumstances of member complaints, appeals, and grievances.The Commercial Appeals & Grievances Supervisor will report to the Commercial Appeals & Grievances Senior Manager.Key ResponsibilitiesBe responsible for...
-
Experienced Operations Coordinator
4 weeks ago
El Dorado Hills, California, United States Blue Shield Of California Full timeYour RoleThe Commercial Appeals and Grievances team conducts thorough investigations concerning the details and situations surrounding member complaints, appeals, and grievances. The Operations Specialist - Experienced will report to a Supervisor within the Commercial Appeals and Grievances department. In this capacity, you will collaborate with the...
-
Care Manager
3 weeks ago
El Dorado Hills, California, United States Blue Shield of California Full timeAbout the RoleAs a Senior Care Manager at Blue Shield of California, you will play a critical role in supporting the mission of our department, which is to provide exceptional care and support to our patients in maintaining health and wellness in the outpatient setting.Key ResponsibilitiesDevelop and Implement Care Plans: Research and design treatment/care...
-
Experienced Operations Coordinator
3 weeks ago
El Dorado Hills, California, United States Blue Shield Of California Full timeJob OverviewYour RoleThe Commercial Appeals and Grievances team is dedicated to conducting thorough investigations concerning member complaints, appeals, and grievances. The Experienced Operations Specialist in this area will report directly to a Supervisor within the Commercial Appeals and Grievances team. In this capacity, you will collaborate with the...
-
People and Culture Manager
4 weeks ago
Beverly Hills, California, United States AppleOne Employment Services Full timeHuman Resources Operations ManagerLocation: Beverly Hills, CA - Onsite (this is not a hybrid role)Salary: $115,000 - $135,000 per yearPosition Overview:We are in search of a skilled and proactive Onsite Human Resources Operations Manager to enhance our team in Beverly Hills. This position demands a committed HR expert with a solid foundation in human...
Manager, Grievance
4 months ago
You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: 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
Education/Experience: 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.
Pay range: $74,200 to $133,400 per year
This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. The employee may be eligible for bonuses and other forms of compensation.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
