RN Manager Grievances & Appeals Job Listing at MedStar Health in Columbia, MD (Job ID 166011)

Description

About the Job

General Summary of Position
Responsible for day to day oversight and management of Intake Clinical Appeals Claims Appeals Complaints Grievances and Intake functions. The Manager of Appeals Complaints and Grievances will be dedicated to delivering service and operational excellence through a focus on continuous improvement in the areas of contribution competencies and performance of the Intake Appeals Complaints and Grievances team. This role will be tasked with overseeing intake the development and operational execution of all appeals (clinical and non-clinical) complaints and grievance processes in line with regulatory standards while enhancing quality and effectiveness. Additionally the role will need to utilize advanced technical knowledge to resolve complex issues. This involves setting objectives creating policies and procedures determining approaches allocating resources and managing inventory.

Primary Duties and Responsibilities

• Bachelor's degree in Nursing required

• 3-4 years Utilization management experience required and
• 5-7 years Diverse clinical experience in a hospital or medical setting required and
• 1-2 years 2 years supervisory experience required
• Additional experience with appeals and grievances preferred

• RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the State of Maryland upon hire and valid RN licensure in the District of Columbia (DC) prior to start date in position. Upon Hire required and
• CCM - Certified Case Manager Active Certified Case Manager (CCM) or CCM certification within 1 Year required

• Excellent verbal and written communication skills.
• Proficient in Microsoft Word Excel and PowerPoint.