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Cencal Health
Santa Barbara, CA, United States
Job Details Job Location Main Office - Santa Barbara, CA Position Type Full Time Job Category Compliance Description Salary Range: $114,138 - $171,207 Job Summary The Medicare Compliance Manager, plays a key role within the Compliance Division, reporting directly to the Chief Compliance Officer (CCO) or alternatively the Compliance Director
Job Source: Cencal HealthCenCal Health
Santa Barbara, CA, United States
Job Details Job Location Main Office - Santa Barbara, CA Remote Type Hybrid Position Type Full Time Education Level Bachelor's Degree Job Category Quality Description Salary Range: $114,138 - $171,207 Job Summary The Quality Department is committed to preventing disease, ensuring patient safety, and eliminating inequities by improving the
Job Source: CenCal HealthCenCal Health
Santa Barbara, CA, United States
Job Details Job Location : Main Office - Santa Barbara, CA Position Type : Full Time Education Level : Bachelor's Degree Salary Range : Undisclosed Job Category : Strategic Investment Description Salary Range: $164,689 - $247,034 Job Summary The CenCal Health Medicare Director will serve as a key leader in the de
Job Source: CenCal HealthCentral California Alliance for Health (Remote)
Santa Barbara, CA, United States
We have an opportunity to join the Alliance as a Senior Medicare Contracts Analyst, internally referenced as Senior Provider Services Contracts Analyst supporting the brand new team focused on recruitment and expansion of our provider network for the Provider Services Department. The Senior Provider Services Contracts Analyst will manage the f
Job Source: Central California Alliance for Health (Remote)J&J Family of Companies
Santa Barbara
Field Reimbursement Manager, Dermatology- Santa Barbara / Big Sur - 2406196088W **Description** **Field Reimbursement Manager Dermatology- Santa Barbara / Big Sur – Johnson & Johnson HCS, Inc.** Johnson & Johnson Innovative Medicine’s Patient Engagement and Customer Solutions (PECS) team is recruiting for a Field Reimbursement Manager which will be
Job Source: J&J Family of CompaniesCencal Health
Santa Barbara, CA, United States
Job Details Job Location Main Office - Santa Barbara, CA Position Type Full Time Education Level Doctorate Job Category Health Services Description California Annual Salary Range: $315,667 - $505,067 Annually Job Summary The Senior Medical Director will provide medical leadership and support the Chief Medical Officer (CMO) to ensure medical
Job Source: Cencal HealthCenCal Health
Santa Barbara, CA, United States
Job Details Job Location Main Office - Santa Barbara, CA Position Type Full Time Job Category Medical Management Description Salary Range: $114,138 - $171,207 Job Summary The Duals Special Needs Program (D-SNP) Care Management Program Manager reports to the Health Services Officer (HSO) and is pivotal in developing, launching, and managing C
Job Source: CenCal HealthCouncil on Alcoholism and Drug Abuse
Santa Barbara, CA, United States
Benefits: 401(k) matching Dental insurance Development Manager The Council on Alcoholism and Drug Abuse (CADA) is seeking a dynamic Development Manager to join its Development team. This is a unique position with the county’s leading provider of life-changing treatment and services for children, teens, adults, and families struggling with subst
Job Source: Council on Alcoholism and Drug AbuseSanta Barbara, CA, United States
Job Details
Job Location
Main Office - Santa Barbara, CA
Position Type
Full Time
Job Category
Member Services
Description
Salary Range: $101,007 - $151,510
Job Summary
The Medicare Grievance and Appeals Manager is a leadership role within the Member Services Department, specializing in the development and management of the Medicare Grievance and Appeals (G&A) function. This pivotal position is dedicated to ensuring compliance with regulatory requirements while enhancing the quality and effectiveness of the Medicare G&A processes. The Medicare Grievance and Appeals Manager possesses strong leadership skills, in-depth knowledge of Medicare regulations, and a commitment to delivering exceptional service to our members.
Duties and Responsibilities:
Develop, implement, and manage the Medicare Grievance and Appeals program including for exclusively aligned products, ensuring compliance with Medicare regulations, CMS and DHCS guidelines, and organizational policies.
Provide leadership and direction to a team of grievance and appeals specialists, fostering a culture of excellence, collaboration, and continuous improvement.
Establish clear goals, performance metrics, and quality standards for the Medicare G&A function. Work with internal reporting resources to establish routine monitoring reports and routinely monitor performance to ensure targets are met or exceeded. Provide regular performance updates to senior leadership and any Quality Improvement and Population Health related committees.
Serve as the subject matter expert on Medicare G&A processes, policies, and regulations, providing guidance and support to internal stakeholders including Member Services, Compliance, Legal, and Clinical teams.
Collaborate with cross-functional teams to identify areas for process improvement and implement solutions to enhance the efficiency and effectiveness of the Medicare G&A function.
Oversee the timely and accurate resolution of Medicare grievances and appeals, ensuring that members receive fair and thorough reviews of their concerns.
Develop and deliver training programs for staff involved in Medicare G&A activities, ensuring that team members have the knowledge and skills needed to perform their roles effectively.
Serve as the primary point of contact for CMS and other regulatory agencies regarding Medicare G&A matters, responding to inquiries, and facilitating audits or reviews as needed.
Qualifications
Knowledge/Skills/Abilities In-depth knowledge of Medicare regulations, CMS guidelines, and industry best practices related to Grievance and Appeals processes.
Strong leadership and management skills, with experience leading teams and driving organizational change.
Excellent communication and interpersonal skills, with the ability to effectively interact with internal and external stakeholders at all levels.
Analytical mindset with the ability to interpret data, identify trends, and make data-driven decisions.
Commitment to quality, accuracy, and compliance with regulatory requirements.
Education and Experience Bachelor's degree in Healthcare Administration, Business Administration, Nursing, or a related field, or an equivalent combination of education and experience.
Master's degree preferred.
Minimum of 5 years of experience in healthcare operations, with a focus on Medicare Grievance and Appeals management.
Email Alert for Medicare Grievance and Appeals Manager jobs in Santa Barbara, CA, United States
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