Manager II Grievances and Appeals (RN)

Elevance Health • Grand Prairie, TX

401d • $95,128 - $148,896

About The Position

The Manager II Grievance/Appeals (RN) is responsible for overseeing the grievances and appeals departmental units within Elevance Health. This role involves investigating, resolving, and responding to grievances and appeals while ensuring quality and regulatory compliance. The manager will coordinate committee meetings, lead audits, and serve as a resource for complex issues related to claims and member services. Additionally, the position requires monitoring trends, analyzing data, and implementing new procedures to support operational objectives and compliance with state and federal regulations.

Requirements

• Bachelor's degree and a minimum of 5+ years grievance & appeals experience.
• A minimum of 3 years of management experience in the healthcare industry.
• Active unrestricted RN license.

Nice To Haves

• Strong oral, written, and interpersonal communication skills.
• Problem-solving skills.
• Facilitation skills.
• Analytical skills.

Responsibilities

• Coordinates Grievance and Appeals Committee Meetings and Member Panel Hearings.
• Leads grievance and appeals in regulated audits.
• Serves as a resource for complex issues and interpretation of claims, provider contracts, and data.
• Oversees and implements new subsystems, procedures, techniques, and supports digital automation objectives.
• Analyzes and develops strategies by achieving performance thresholds within budgetary guidelines.
• Monitors trends and analyzes grievance and appeals data to identify and recommend plan and policy changes.
• Ensures programs support overall QI program and meet regulatory compliance/accreditation and company standards.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution
• Paid holidays
• Paid Time Off
• Medical, dental, vision benefits
• Short and long term disability benefits
• Life insurance
• Wellness programs
• Financial education resources

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree
• Number of Employees: 11-50 employees