Manager Clinical Appeals and Grievances

**Duties and Responsibilities:**

+ Manages a team of specialists, with responsibility forgoal and productivity management, coaching and counseling, performance management and other leadership responsibilities as assigned
+ Provides oversight in case research and provides advice as needed
+ Understands HFs internal health plans policies and procedures to frame decisions
+ Interprets regulations to provide guidance to specialists on a daily basis
+ Ensures the timely resolution of cases and makes critical decisions
+ Focuses on clinical criteria for expedited cases
+ Helps standardize and optimize how Appeals and Grievances are routed
+ Determine best practices and strategically deploy approaches to meet production, compliance and quality targets
+ Works with leadership to establish and implement departmental goals, establish monthly goal review process and implement a plan of action for identified gaps
+ Provides guidance in the preparation of case pr...