Supervisor, Quality Performance & Grievance and Appeals
About The Position
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.
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.
Benefits
- Medical, Dental and Vision insurance
- 403(b) Retirement savings plans with employer matching contributions
- Flexible Spending Accounts
- Commuter Flexible Spending
- Career Advancement & Development opportunities
- Paid Time Off & Holidays
- Paid CME Days
- Malpractice insurance and tail coverage
- Tuition Reimbursement Program
- Corporate Employee Discounts
- Employee Referral Bonus Program
- Pet Care Insurance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
