Samaritan Health Services · 4 hours ago
Manager of Grievance and Appeals
United States
Full-time
Remote
Mid Level
3+ years exp
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Hiring Manager
Thomas Fishe
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Responsibilities
Accountable for leading Samaritan Health Plan Operations appeals and grievance functions.
Ensures timely, accurate and appropriate responses to inquiries, grievances and appeals from members, external providers and regulators.
Provides leadership for the policy and strategic direction of appeals and grievance including outcome improvement supporting business needs within all lines of business including, but not limited to identification and reduction in causal performance issues, regulatory compliance, STAR improvement and risk management/mitigation.
Directly responsible for the management of various components of appeals and grievance including, but not limited to commercial A&G and provider disputes for all LOB.
Works collaboratively with operational leaders to assure compliance with company-wide policy and standards.
Identifies and leads company-wide process, outcome and efficiency solutions.
Qualification
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Required
Bachelor's Degree or equivalent experience required.
Three (3) years progressive leadership experience required.
Three (3) years experience with managed care required.
Experience or training in computer applications including electronic documentation required.
Preferred
Master's Degree preferred.
Experience with Medicare Part D strongly preferred.
Two (2) years significant site management experience including leading large teams and managing cross functional teams preferred.
Company
Samaritan Health Services
Samaritan Health Services provides compassionate, innovative and quality health care serving communities.
5,001-10,000 employees
H1B Sponsorship
Samaritan Health Services has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2022 (1)
2021 (1)
Funding
Current Stage
Late StageLeadership Team
Marty Cahill MBA, FACHE
Chief Executive Officer
Brandon Schmidgall
Chief Operating Officer
Recent News
Company data provided by crunchbase
