VP, Grievance & Appeals - Remote

Overview

The VP of Grievance & Appeals will lead the enterprise's multi-state operations to ensure accurate and timely decisions regarding clinical and administrative appeals, payment disputes, and complaints. This role involves developing policies, ensuring compliance, and driving improvements across various operational areas.

In Short

• Lead Grievances and Appeals operations for timely member/provider decisions.
• Establish and implement policies and procedures for compliance.
• Drive cross-functional collaboration to identify and address process failures.
• Oversee operational performance across multiple departments.
• Serve as liaison with regulatory agencies.
• Manage complex enterprise implementations for compliance outcomes.
• Ensure high-quality contact center operations.
• Leverage technology for improved customer responsiveness.
• Provide strategic and budgetary leadership.
• Recruit and retain high-performing teams.

Requirements

• Bachelor’s degree required; Master’s preferred.
• 12-15+ years in managed care with a focus on operations.
• Experience managing remote teams across multiple locations.
• Strong knowledge of compliance regulations.
• Proven track record in performance metrics development.
• Excellent communication and presentation skills.
• Proficient in MS Office tools.
• Strong stakeholder engagement skills.

Benefits

• Opportunity to lead and influence enterprise operations.
• Work in a collaborative and innovative environment.
• Professional development and growth opportunities.
• Competitive salary and benefits package.
• Flexible working arrangements.