Anticipated End Date:

2024-11-04

Position Title:

Provider Grievance and Appeals Program Manager, Senior

Job Description:

Grievance and Appeals Program Manager, Senior

Location: Kansas. This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Kansas Elevance Health PulsePoint locations.

The Grievance and Appeals Program Manager, Senior​ will be responsible for managing Provider Grievances, Provider Appeals, and Provider State Fair Hearings for the Kansas Health Plan.

Responsible for working with management to identify and implement varied projects, programs and plans that support achievement of business unit and enterprise goals.

Primary duties to include, but are not limited to:

• Identifies potential issues, project change, and scope.

• Leads efforts to identify best practices. Identifies impacted parties, business partners, and resources required.

• Develops and designs processes and systems that support business needs.

• Designs methods for integrating function and process.

• Conducts cost/benefit analyses.

• Builds support for business change throughout the business unit.

Minimum Requirements:

• Requires a BA/BS in a related field and minimum of 8 years process improvement, business change or project related experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Experience in successfully developing and managing projects with fairly significant operating budget and knowledge of process redesign strongly preferred.

• Experience with Member Grievances, Appeals, administrative hearings, or other legal processes strongly preferred.

• Experience with accurate, complete, and timely regulatory documentation and submission is strongly preferred.

• Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

• Experience as a legal assistant or paralegal or comparable education or employment experience is strongly preferred.

Job Level:

Non-Management Exempt

Workshift:

Job Family:

BSP > Business Support

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.