Manager II Medical Management, Grievance and Appeals CA RN required
Core
Manage a team of clinicians to promote quality member outcomes, optimize member benefits, and ensure effective use of resources in a managed care environment.
Role type
Senior IC Manager II Medical Management (Grievance and Appeals)
Builds
Member health outcomes and optimized benefit utilization
Domain
Healthcare / Managed Care
Required skills
Acute care clinical nursing, Medical policy interpretation, Managed care product knowledge, Care coordination, Team management, Budget management, Hiring and performance evaluation
Preferred skills
Trauma or ER clinical nursing, Inventory management oversight, Health plan experience, California DMHC experience, Bachelor's degree
Technologies
None stated
Responsibilities
Ensure adherence to medical policy and member benefits; Authorize inpatient admissions, outpatient services, and surgical/diagnostic procedures; Apply clinical knowledge for care coordination; Manage appeals for denied services; Mentor lower-level managers; Develop and manage annual operating budget; Hire, train, coach, and evaluate direct reports
Seniority
Manager II, hands-on leadership