City/State

Work Shift

Overview:

Sentara Health Plans is hiring a Supervisor, Appeals and Grievances for Medicaid- Remote in Virginia!

Status: Full-time, permanent position (40 hours)

Standard working hours: 8am to 5pm EST, M-F.

Location: Remote in Virginia

Overview

• Assumes responsibility, accountability and leadership for the daily operations.

• First line supervisor in the Department responsible for quality and service. Facilitates the work of assigned team members.

• Responsible for leading the Appeals efforts, providing oversight, training and guidance to the team.

• Conducting in-depth investigation and documentation of member appeals and grievances in compliance with State law, applicable rules and regulations and provider and group agreements.

• Works closely with the Plan's Medical Directors who are responsible for all decision regarding clinical appeals/ grievances and the Appeals Manager who is responsible for non-clinical appeals and grievances.

• Provide training and/or presentations to staff, external brokers and providers.

• Knowledgeable of full range of products at Sentara Health Plans.

• Manage a team of up to 10 Appeals and Grievances Coordinator

Education

• Bachelor’s Level Degree OR 5 or more years of Medicare appeals at a health plan REQUIRED

Certification/Licensure

• None required

Experience

• Managed Care- 5 years of experience REQUIRED

• Healthcare Complaints/Appeals- 3 years of experience REQUIRED

• Previous member appeals and grievances in Medicaid experience preferred; Medicare experience is acceptable

• Supervisory experience preferred

Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.

Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.

We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health.

Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.

Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-96189

Talroo - Health Plan

Health Plan, Healthcare, Health Insurance, MCO, Managed Care, Remote, Virginia, VA, Appeals, Claims, Grievance, Denials, Pre-authorization, Member, Medicaid, Medicare, Supervisor, Team Coordinator

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission “to improve health every day,” this is a tobacco-free environment.

For positions that are available as remote work, Sentara Health employs associates in the following states:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.