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Manager, Appeals & Grievances RN

Job Category: Appeals & Grievances

Location: New York, NY, United States

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Job Description

Description

The Manager Appeals & Grievances serves as the advanced level subject matter expert for determination of non-clinical and/or clinical matters. The Manager supervises day-to-day departmental activities including, but not limited to, oversight of staff and the A&G processes.

- Maintains staff productivity, effectiveness and efficiency. The A&G Manger is responsible for responding to all staff questions regarding A&G processes and timeframes. The Manager assigns workloads and manages staff productivity by randomly auditing and reviewing work assignments.
- Monitors quality of records via monthly audits of staff cases. The A&G Manager performs monthly audits of staff cases to ensure that all regulatory timeframes are met and that staff is adhering to departmental policies and workflows.
- Conducts monthly staff meetings to update staff on new policies and reinforce current policies within the department.
- Supervises and assists with training of new staff and attend Partnership trainings (requires travel within NY Tri-State). Participate in all aspects of personnel management to ensure appropriate staffing, orientation, support, discipline and timely performance appraisals. Ensure that probationary and annual performance appraisals are completed in an objective manner; that employees are encouraged to complete their self-evaluation and that appraisals are completed in a timely manner. Meet regularly with direct reports to review goals, trends and performance measures and to facilitate change.
- Develops reports necessary to monitor/track operational efficiency.
- Additional duties as assigned

Minimum Qualifications:

  • NYS RN

 Preferred Qualifications:

  • Previous relevant work experience
  • Supervisory or training experience
  • Demonstrated professionalism and leadership skills along with ability to develop, direct, and support a team 
  • Time management, critical/creative thinking, communication, and problem-solving skills
  • Adept at planning, organizing, and executing
  • Ability to build and enhance team productivity

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law, and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [email protected] or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

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