A company is looking for a Manager of Health Plan Operations.
Key Responsibilities
Process appeals for denied or partially denied services, communicating with participants, caregivers, and the Interdisciplinary Team
Manage the grievance process, including investigations and corrective actions, while coordinating with relevant teams and external contractors
Oversee vendor relationships and ensure compliance with CMS and DHCS regulations through credentialing and monitoring
Required Qualifications
3+ years of customer service experience, including formal leadership experience
Experience with federal and state regulatory compliance, particularly in appeals and grievances
Health plan experience is required; PACE experience is preferred
Bachelor?s degree or equivalent experience in a healthcare-related field
Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint)
