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.
