Grievance & Appeals Manages and coordinates Bachelor's Degree in 5 Des Moines, Manager grievance and appeals Health Administration, IA program monitoring and Business, Nursing, or compliance testing for the related field Required Health Services, Quality Grievance and appeals and Market functions. experience related to Responsible for the compliance, regulatory, closure of corrective claims, and/or provider actions and process services improvements activities. Experience in the health Plans and directs activities care industry within appeals and grievances including audits and Administrative Law Judge (ALJ) hearings. Quality Management Plans, develops and Iowa license (physician, 7 Des Moines, Manager directs the Quality or IA physician’s assistant, Improvement functions. nurse) or relevant (Director, Quality Accountable for QI certification (i.e., CPHQ, Improvement) project managers and NAHQ) clinical practice advisors Degree in Bachelor’s dedicated to improvement HealthCare, Nursing, of targeted HEDIS Public Health, Health measures, along with Administration or related preparation for field of WellCare Direct experience with of Iowa. Ensures Quality Improvement job compliance with state, functions federal and accreditation Managed care experience requirements. Experience with accreditation
Grievance & Appeals Manager Manages and coordinates grievance and appeals program monitoring and compliance testing for the Health Services, Quality and Market functions. Responsible for the closure of corrective actions and process improvements activities. Plans and directs activities within appeals and grievances including audits and Administrative Law Judge (ALJ) hearings. Bachelor's Degree in Health Administration, Business, Nursing, or related field Required Grievance and appeals experience related to compliance, regulatory, claims, and/or provider services Experience in the health care industry 5 Des Moines, IA Quality Management Manager (Director, Quality Improvement) Plans, develops and directs the Quality Improvement functions. Accountable for QI project managers and clinical practice advisors dedicated to improvement of targeted HEDIS measures, along with preparation for of WellCare of Iowa. Ensures compliance with state, federal and accreditation requirements. Iowa license (physician, physician’s assistant, or nurse) or relevant certification (i.e., CPHQ, NAHQ) Bachelor’s Degree in HealthCare, Nursing, Public Health, Health Administration or related field Direct experience with Quality Improvement job functions Managed care experience Experience with accreditation 7 Des Moines, IA
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