Manager, Customer Care Medicare Strategy

CareSource • Ohio WFH, OH

3d • $83,000 - $132,800

About The Position

The Manager, Customer Care Medicare Strategy provides oversight of the Grievance, Appeals, IRE/IRO, and State Hearing teams within CareSource. The role leads staff and manages the timely, accurate handling of work while ensuring departmental goals, regulatory requirements, and accreditation standards are met. It oversees grievance and appeal resolution, reporting, training, process development, and operational improvement, including support for new product lines. The manager monitors trends and regulatory changes, analyzes data, works across business areas to identify root causes, and reports findings to appropriate CareSource committees. The position also promotes accountability and flexibility in support of CareSource’s mission and vision.

Requirements

• Bachelor’s degree or equivalent years of relevant work experience.
• Proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint.
• Basic experience with ACD systems.
• Basic experience with Call Management Systems.
• Excellent written and verbal communication skills.
• Strong interpersonal skills, professionalism, and a collaborative management style.
• Effective problem-solving skills and attention to detail.
• Effective listening and critical-thinking skills.
• Ability to work independently and within a team environment.
• Ability to develop, prioritize, and accomplish goals.
• Strategic management skills.
• Familiarity with the healthcare field and knowledge of Medicaid and Medicare.
• Ability to work in a fast-paced and constantly changing environment.

Nice To Haves

• Prior experience in the healthcare industry.
• At least three years of management experience.
• At least four years of grievance and appeals experience.

Responsibilities

• Provide leadership and direction to staff to achieve department and CareSource goals and standards.
• Manage staff to ensure tasks and issues are completed accurately and on time.
• Oversee and monitor processes for compliance with regulatory requirements and accreditation standards.
• Ensure grievances and appeals are resolved and reported appropriately.
• Analyze and provide feedback to areas that submit grievances and appeals.
• Develop, implement, and deliver grievance and appeal training to business areas as needed.
• Evaluate operations and identify process improvements.
• Identify irregular grievance and appeal trends and work with other areas to determine root causes and resolutions.
• Monitor trends and regulatory changes for their impact on the department.
• Report data to appropriate CareSource committees.
• Oversee, develop, and execute grievance and appeal processes for new product lines.
• Review and interpret regulatory requirements and ensure business policies and processes comply.
• Lead initiatives to track and trend grievance and appeal data to drive process improvements.
• Develop a culture of accountability and flexibility within the team in support of the organizational mission and vision.
• Perform other job duties as requested.

Benefits

• Potential eligibility for a bonus tied to company and individual performance.
• A substantial and comprehensive total rewards package focused on employee well-being.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager