Supervisor, Quality Performance & Grievance and Appeals

AltaMed•Montebello, CA

5d•Onsite

About The Position

Grow Healthy If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn’t just welcomed – it’s nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don’t just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it’s a calling that drives us forward every day. Job Overview The Supervisor, Quality, Grievance & Appeals is responsible for the daily oversight, coordination, and performance of all Grievance & Appeals (G&A) functions, while also leading key Quality Management activities that drive regulatory compliance and organizational performance. The Supervisor supports the execution of enterprise quality initiatives, including HEDIS, CMS Star Ratings, DMHC quality performance measures, and internal quality improvement programs. This position collaborates closely with Quality leadership, Utilization Management, Population Health, and operational teams to identify trends, implement corrective actions, and promote a positive member and provider experience. This role provides supervision to both clinical and non‑clinical staff and ensures timely, accurate, and compliant processing of grievances and appeals, potential quality issues (PQIs), and quality-of-care reviews.

Requirements

Bachelor’s degree in healthcare administration, public health, nursing, or a related field (or equivalent experience).
Minimum of 3 years of experience in healthcare grievances and appeals, quality, compliance, or managed care operations.
Minimum of 2 years of healthcare quality improvement or performance measurement experience (HEDIS/Stars preferred).
Experience conducting PQI/QOC reviews or supporting clinical quality investigations.
Minimum 1 year of supervisory or lead experience.
Current LVN license issued by the State of California, Vocational Nursing, and Psychiatric Technicians
A minimum requirement of a valid BLS certification or higher, following the American Heart Association (AHA) or the American Red Cross guidelines.

Nice To Haves

HEDIS/Stars preferred experience

Responsibilities

Daily oversight, coordination, and performance of all Grievance & Appeals (G&A) functions.
Leading key Quality Management activities that drive regulatory compliance and organizational performance.
Supporting the execution of enterprise quality initiatives, including HEDIS, CMS Star Ratings, DMHC quality performance measures, and internal quality improvement programs.
Collaborating closely with Quality leadership, Utilization Management, Population Health, and operational teams to identify trends, implement corrective actions, and promote a positive member and provider experience.
Providing supervision to both clinical and non‑clinical staff.
Ensuring timely, accurate, and compliant processing of grievances and appeals, potential quality issues (PQIs), and quality-of-care reviews.