The Medicare Grievances & Appeals Manager is responsible for direct oversight of operational and personnel management activities of the Medicare Grievances & Appeals team. The manager will ensure that plan members and practitioners are educated on how to properly submit a formal grievance and/or appeal in a timely manner. The manager will participate in quality improvement activities related to grievances and/or appeals, interacting closely with Medical Directors, Quality team, Compliance, Regulatory, Medical Management, as well as Claims staff. This manager will ensure supervision, investigation and resolution of member and practitioner grievances and/or appeals pursuant to Center for Medicare and Medicaid Services (CMS), Department of Medical Assistance Services (DMAS), and National Committee for Quality Assurance (NCQA), to include resolving grievances and/or appeals within the required timeframes. This position shall also be responsible for serving as the plan’s primary Medicare liaison for the members and practitioners grievances and/or appeals.
MINIMUM EDUCATION REQUIREMENTS
SPECIAL KNOWLEDGE AND/OR SKILLS
Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs. Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia.
We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.
All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE
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