RN Grievance and Appeals Supervisor
Overview
Full-time RN Grievance and Appeals Supervisor in Los Angeles, CA offering competitive compensation and career growth opportunities.
What You'll Do11
- 1Ensures adequate/appropriate distributions of workforce, assignments and time off requests
- 2Monitors staff performance including productivity and compliance with regulatory requirements
- 3Develops tools, job aids, and workflows to optimize process flow and performance
- 4Completes intermittent and annual staff evaluations
- 5Serves as primary resource for business-related questions and escalates issues
- 6Recommends and implements process improvement measures to achieve performance outcomes
- 7Plans and oversees A&G clinical activities according to model of care
- 8Maintains reporting responsibilities and conducts regular audits for compliance
- 9Assists in development of programs, training materials, and competency checklists
- 10Trains new staff and provides cross-training as needed
- 11Leads and mentors staff while serving as technical and informational resource
Requirements8
- 1At least 8 years of RN acute/clinical care experience
- 2At least 2 years in a lead/supervisory experience
- 3Previous experience in Medicare/Medicaid managed care environments
- 4Knowledge of state federal and regulatory requirements in appeals and utilization management
- 5Strong verbal and written communication skills
- 6Proficiency in Microsoft Word Excel and other core departmental systems
- 7Excellent organizational time management and interpersonal skills
- 8Detail-oriented energetic and enthusiastic team player attitude
Salary Insight
$102 - $131k per year
Location
Required Skills
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