University of Utah Health Care

  • Health Plan Grievance and Appeals Supervisor

    Requisition Number
    35152
    Reg/Temp
    Regular
    Employment Type
    Full-Time
    Shift
    Day
    Work Schedule
    Monday through Friday 8:00-5:00
    Location Name
    University of Utah Health Plans
    Patient Care?
    No
    City
    Murray
    State
    UT
    Department
    UIP CST 01H UUHP COMPLIANC DIR
    Category
    Insurance / Health Plans
  • Overview

    As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. EO/AA

    Supervise the day-to-day activities of staff who process member and provider Grievance and Appeals. Monitor and set goals for staff workloads. Ensure that staff are processing Grievances and Appeals efficiently and in compliance with applicable policies, regulations, and requirements. Provide education to staff and other departments on Appeals and Grievances. Develop process improvement initiatives, including initiatives based on appeal trends and outcomes.

    Responsibilities

    • Lead the Appeals/Grievances program and team, monitor staff performance, attendance, schedules and other job related behavior.
    • Offers regular support, feedback, counseling, and corrective action; conduct a yearly performance review.
    • Develops and maintain auditing and reporting to ensure consistent application of policies and procedures.
    • Maintains program policies and procedures.
    • Ensures correct documentation, and safekeeping of appeals and grievances.
    • Responds to program audits, as needed.
    • Analyzes appeal trends, develop and implement process improvement initiatives based off of appeal trends.
    • Writes and maintain program policies and procedures, ensuring the policies and procedures are compliant with applicable law.
    • Develop and conduct training, both for the team and for other parts of the organization.
    • Participates in other projects as required.

    Knowledge / Skills / Abilities

    • Ability to perform the essential functions of the job as outlined above.
    • Demonstrated strong leadership skills.
    • Ability to be self-motivated and can work with moderate direct supervision.
    • Demonstrated Familiarity with Local, State, and Federal statutes to ensure program is operated in accordance with applicable law.
    • Demonstrated understanding of insurance appeals and grievance processes.
    • Demonstrated experience in improving workflows, and creating operational efficiencies.
    • Demonstrated attention to detail.
    • Demonstrated strong critical thinking skills.
    • Demonstrated understanding of enrollment, medical coding, medical claims.
    • Ability to establish good relationships with internal and external stakeholders.
    • Strong verbal/written communication skills.

    Qualifications

    Qualifications

    Required

    • Bachelor's degree in a related field or equivalency.
    • Three years of experience in a health insurance environment, preferably in managed care appeals and grievances.

    Qualifications (Preferred)

    Working Conditions and Physical Demands

    Employee must be able to meet the following requirements with or without an accommodation.

    • This is a sedentary position in an office setting that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects while providing patient care to those with psychiatric conditions.

    Physical Requirements

    Carrying, Climbing, Far Vision, Lifting, Listening, Manual Dexterity, Near Vision, Pulling and/or Pushing, Reaching, Sitting, Speaking, Standing, Stooping and Crouching, Walking

    Options

    Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
    Share on your newsfeed