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Manager, Grievances and Appeals Operations at SCAN Health Plan - ApplyBlast

Manager, Grievances and Appeals Operations

SCAN Health Plan

26 days ago

3.5 on Glassdoor

Long Beach, California, United States

Hybrid

Full Time

Manager

0 applicants

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About this role

The Manager, Grievances and Appeals Operations oversees daily operations within the SCAN Grievance and Appeal program to ensure efficient and effective delivery of member rights in compliance with regulatory standards. This role involves managing team productivity, implementing process improvements, and ensuring staff adherence to CMS, DMHC, and DHCS guidelines. The position requires strong leadership to drive quality case reviews and support organizational goals through strategic planning and stakeholder collaboration.

Responsibilities

Manage daily operations and productivity of the Grievance and Appeals team
Ensure compliance with CMS, DMHC, DHCS, and NCQA regulatory standards
Train staff to review inquiries and classify cases for Pharmacist or Medical Director review

Skills

About SCAN Health Plan

scanhealthplan.com

SCAN Health Plan is a nonprofit Medicare Advantage health plan operating as an HMO under Medicare. It provides comprehensive coverage with additional benefits such as dental, vision, prescription drugs, OTC allowances, and transportation, serving beneficiaries in California, Arizona, Nevada, New Mexico, Texas, and Washington.