Newton-Wellesley Hospital(NWH)
Duals Supervisor, Appeals and Grievances
NewWhat's your preference?
Job Description
- Req#: RQ4029852
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Salary up to $113,453.60 annually
- Comprehensive benefits package including career advancement opportunities and recognition programs
- Flexible remote work arrangement with occasional onsite meetings
- Opportunity to lead and develop a high-performing team in a mission-driven organization
- Engage in strategic projects that impact operational efficiency and customer satisfaction
What to Expect (Job Responsibilities):
- Supervise daily operations of a team of 4-6 appeals and grievance coordinators
- Ensure compliance with regulatory requirements and internal performance standards
- Collaborate with various departments to facilitate timely resolution of appeals and grievances
- Conduct regular meetings and provide real-time oversight and training for staff
- Present operational metrics and propose solutions for performance improvement to leadership
What is Required (Qualifications):
- Bachelor’s degree required; advanced degree such as a master's or RN preferred
- 5-7 years of experience in health plan operations, specifically in appeals and grievances
- 2-3 years of experience with Medicare and/or Dual Special Needs Programs operations
- 3 years of experience in managing and training staff within an appeals and grievances department
- Proven ability to represent and address the needs of staff and executive leadership
How to Stand Out (Preferred Qualifications):
- Experience in setting up appeals and grievances workflows across new products and plans
- Strong problem-solving skills and the ability to build effective relationships across teams
- Familiarity with NCQA, CMS, and other regulatory bodies related to appeals and grievances
#HealthcareServices #LeadershipOpportunity #RemoteWork #CareerGrowth #CompetitiveSalary
We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.
We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
Notice
Talentify is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Talentify provides reasonable accommodations to qualified applicants with disabilities, including disabled veterans. Request assistance at accessibility@talentify.io or 407-000-0000.
Federal law requires every new hire to complete Form I-9 and present proof of identity and U.S. work eligibility.
An Automated Employment Decision Tool (AEDT) will score your job-related skills and responses. Bias-audit & data-use details: www.talentify.io/bias-audit-report. NYC applicants may request an alternative process or accommodation at aedt@talentify.io or 407-000-0000.