Manager - Grievance/Appeals (RN) ID-1660

Job description

Are you a compassionate and driven registered nurse with a passion for helping others? Do you have experience in managing grievance and appeals processes? If so, we have an exciting opportunity for you to join our team as Manager of Grievance/Appeals at Elevance Health.As a leader in the healthcare industry, we are committed to providing our members with the highest quality of care and support. In this role, you will play a crucial role in ensuring that our members' concerns and complaints are addressed effectively and efficiently.
Your strong clinical background and exceptional communication skills will be essential in navigating complex cases and working with various stakeholders to reach resolutions.If you are a self-motivated and empathetic individual with a keen eye for detail, we invite you to apply for this position and make a meaningful impact on the lives of our members. Read on for more details about the qualifications and responsibilities required for this role.

Oversee the grievance and appeals processes for Elevance Health, ensuring timely and effective resolution of member concerns and complaints.

Utilize strong clinical knowledge and experience to evaluate and analyze complex cases and make informed decisions.
Collaborate with internal teams, external stakeholders, and regulatory agencies to address and resolve member grievances and appeals.
Develop and implement policies and procedures for the grievance and appeals processes, ensuring compliance with regulatory requirements.
Provide guidance and support to team members on best practices for managing and resolving grievances and appeals.

Maintain accurate and detailed records of all grievance and appeal cases, including documentation of decisions and resolutions.
Conduct thorough investigations and reviews of member grievances and appeals, including gathering and reviewing relevant medical records and other supporting documentation.
Communicate effectively and compassionately with members, their families, and other involved parties to address and resolve concerns.
Stay updated on industry trends and regulatory changes related to grievance and appeals processes, and make recommendations for process improvements.

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Uphold the values and mission of Elevance Health in all interactions and decisions related to member grievances and appeals.
Participate in training and development opportunities to enhance knowledge and skills related to managing grievances and appeals.
Ensure confidentiality and privacy of all sensitive information related to member grievances and appeals.

Elevance Health is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.
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