Location
Spokane, WA, United States
Posted on
Nov 04, 2021
Profile
Job Information
Humana
Associate Director/Grievances and Appeals-Remote/Virtual in US
in
Spokane
Washington
Description
The Associate Director, Grievances & Appeals manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an a grievance, appeal or further request is warranted and then delivers final determination based on trained skillsets and/or partnerships with clinical and other Humana parties. The Associate Director, Grievances & Appeals requires a solid understanding of how organization capabilities interrelate across department(s).
Responsibilities
Where you Come In
The Associate Director, Part C Operational Support provides data-based strategic direction to identify and address business issues and opportunities. This role provides business intelligence and strategic planning support for the Resolution Part C Appeals. The Associate Director, Part C Operational Support requires a solid, in-depth understanding of how Part C Appeals capabilities interrelate across RT, CPSS, and the enterprise. The Associate Director leads initiatives to analyze complex business problems and issues using data from internal and external sources. Additionally, the Associate Director brings expertise or identifies subject matter experts in support of multi-functional efforts to identify, interpret, and produce recommendations and plans based on company and external data analysis.
Oversee and develop the Operational Support team which is critical to aiding Operations in remaining compliant with case work
Project Manage the strategy initiatives for Part C Appeals and align to both RT and CPSS strategy road map
Develop presentations/dashboards that help showcase the work of the area for forums for Executive leaders and RT
Ensures that policies and procedures align with corporate vision
What Humana Offers
We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.
Required Qualifications - What it takes to Succeed
Bachelor's Degree
Minimum of 5 years progressive operational experience in a management role with oversight of 50 to 100 associates
Experience in healthcare operations
Ability to hold others accountable and maintain a professional work environment
Prior demonstrated experience with process improvement and implementation
Project Management experience
Experience with prioritizing and balancing multiple responsibilities and projects
Both strategic and tactical thinking and planning capabilities; organized and detail-oriented
Strong communication skills with the ability to influence effectively
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Must be able to work in the EST zone and have the ability to travel overnight up to 25% of the time within the US
We will require full COVID vaccination for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates and the communities we serve.
If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law.
Preferred Qualifications
Knowledge of Humana's internal policies, procedures, and systems
Six Sigma, Lean (or other quality program) background
Grievance and Appeals experience
Additional Information - How we Value You
Benefits starting day 1 of employment
Competitive 401k match
Generous Paid Time Off accrual
Tuition Reimbursement
Parent Leave
Go365 perks for well-being
Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work.
Must have accessibility to high speed DSL or cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10M x 1M
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.
#ThriveTogether #WorkAtHome
Scheduled Weekly Hours
40
Company info
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