Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
If this sounds like you, read on!
The Exchange Grievances & Appeals Manager is responsible for direct oversight of operational and personnel management activities of the Exchange 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, Accreditation team, Compliance, Regulatory team, Medical Management, and Claims staff. This manager will ensure supervision, investigation and resolution of member and practitioner grievances and/or appeals pursuant to Virginia Premier’s internal policies and ensure compliance with regulatory requirements, include resolving grievances and/or appeals within the required timeframes. This position shall also be responsible for serving as the plan’s primary Exchange liaison for the members and practitioners grievances and/or appeals.
POSITION DUTIES AND RESPONSIBILITIES
MINIMUM EDUCATION REQUIREMENTS
SPECIAL KNOWLEDGE AND/OR SKILLS
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
Our mission is to inspire healthy living within the communities we serve!