Senior Director managing grievance and appeals for L.A. Care Health Plan. Overseeing operations and regulatory compliance for healthcare services in Los Angeles.
Responsibilities
Direct oversight of L.A. Care’s grievance, appeal, and State Fair Hearing functions
Ensure all cases are processed accurately and consistently with exceptional quality
Develops strategic plans and drives change
Collaborate extensively with cross-functional key stakeholders
Strengthen preventive controls and improve service delivery
Fosters a culture of proactive issue identification and operational improvement
Requirements
Bachelor's Degree
At least 9 years of experience in health plan operations, managed care, A&G, utilization management, clinical operations, or regulatory compliance
At least 8 years of leading staff, supervisor/management experience
Extensive leadership experience in Medicaid, Medicare, and Commercial managed care lines of business
Experience navigating regulatory and accreditation requirements
Strong track record of applying complex regulatory standards to grievance, appeal, and quality-of-care operations
Experience leading organizations through high-stakes regulatory audits
Preferred: Registered Nurse (RN) - Active, current and unrestricted California License
Benefits
Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)
Job title
Senior Director, Grievance Officer – Appeals and Grievances
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