Manager II Grievance/Appeals (RN)

Manager II Grievance/Appeals – Claims Support

Location: *CA Residential Requirement

This position will work a hybrid model (remote and office). Ideal candidates will live in the state of California within 50 miles of one of our PulsePoint locations.

The Manager II Grievance/Appeals is responsible for management oversight of grievances and appeals departmental units to investigate, resolve, and respond to client/provider grievances/appeals and ensure compliance with regulatory requirements.

How you will make an impact:

•Maintains and coordinates staff activities to achieve departmental and corporate goals to improve service to customers/providers and assures regulatory compliance.

•Analyzes and develops strategies by achieving performance thresholds within budgetary guidelines.

•Addresses both internal/external customer/provider needs and concerns related to team activities.

•Ensures programs support overall QI program and meet regulatory compliance/accreditation and the company standards.

•Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Minimum Requirements:

•Requires a minimum of 5+ years grievance & appeals experience and a minimum of 3 years of management experience in the healthcare industry; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• BA/BS preferred.

•Medicaid experience

•RN

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $79,360 to $142,848.

Locations: California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.