Manager, Customer Care Medicare Strategy

Job Summary: The Manager, Grievance and Appeals is responsible for oversight of the Grievance, Appeal, IRE/IRO and State Hearing teams within CareSource . Essential Functions: Provide leadership and direction to staff to ensure the goals and standards of the department and CareSource are successfully achieved Manage staff to ensure timely and accurate completion of tasks and issues are accomplished Oversee and monitor processes to ensure department is meeting all regulatory requirements and accreditation standards Oversee and ensure grievances and appeals are resolved and reported appropriately Oversee, analyze and provide feedback to all areas that submit grievances and appeals Develop, implement and execute grievances and appeals training to business areas as needed Analyze and evaluate operations and identify process improvement Identify irregular trends with grievances and appeals; work with other areas as appropriate to identify root causes and appropriate steps for resolution Monitor trends and regulatory changes for impact to the department Report data to appropriate committees with CareSource Oversee, develop and execute the grievances and appeals process for new product lines Review and interpret regulatory requirements and ensure business policies and processes are in compliance Lead initiatives to track and trend grievances and appeals data in order to drive process improvements Develop a culture of accountability and flexibility within the team to support the orga