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The Center for Integration Science is seeking a Manager for Appeals and Grievances who will oversee the processing of member appeals and grievances for Medicaid and Commercial product lines. This role requires strong leadership skills, extensive knowledge of healthcare regulations, and the ability to analyze data to ensure compliance and operational efficiency.
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Job Summary
The role leads a team responsible for the processing of all Member Appeals and Grievances for Medicaid and Commercial product lines while ensuring compliance with state and federal regulations.
This is a remote role that will require an on-site presence at the office at least quarterly for leadership and staff meetings within a welcoming and supportive environment.
The position offers competitive salaries, a benefits package with flexible work options, career growth opportunities, and the chance to contribute to one of the world's leading integrated healthcare systems.
Matching Summary
Match Score: 75
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The Center for Integration Science is seeking a Manager for Appeals and Grievances who will oversee the processing of member appeals and grievances for Medicaid and Commercial product lines. This role requires strong leadership skills, extensive knowledge of healthcare regulations, and the ability to analyze data to ensure compliance and operational efficiency.
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Salary
Base: $99,465.60 - $141,804.00/Annual; Bonus/Equity: Not specified; Benefits: Competitive salaries, comprehensive benefits package, flexible work options, career growth opportunities
Skills & Requirements
Must-have
Massachusetts Registered Nurse license required
5-7 years appeals or grievances experience
2-3 years supervisory or management role
Knowledge of Medicaid Medicare Commercial insurance
Compliance with state federal regulations
Nice-to-have
Strong leadership and team management abilities
Excellent analytical and problem-solving skills
Ability to manage multiple priorities
Effective communication and interpersonal skills
Proficiency in revenue cycle management tools
Key Requirements
Bachelor's Degree or equivalent combination of training and experience