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Program/Policy Analyst Sr (Medi-Cal Compliance) CalOptima CalOptima Health is seeking a highly motivated Program/Policy Analyst Sr (Medi-Cal Compliance) to join our team. The Program/Policy Analyst Sr (Medi-Cal Compliance) will coordinate and maintain CalOptima Health's relationship with regulatory agencies and ensure CalOptima Health and its First Tier, Downstream and Related Entities (FDRs) comply with all appropriate standards, regulations, contractual provisions, federal waivers and laws. Specifically, the incumbent works to enhance and strengthen CalOptima Health's policy infrastructure, platform and strategies at the state level, including contract compliance, statutory and regulatory obligations with the Department of Health Care Services (DHCS). The incumbent requires the ability to complete a variety of independent detailed analyses, including the development, review and response to corrective action plans. The incumbent will be responsible implementing Corrective Action Plans (CAPs), supporting regulatory audits, validating regulatory guidance and developing regulatory communications for CalOptima Health stakeholders. The incumbent will interact with CalOptima Health's executives and department management, FDR's management, legal counsel and state and federal regulatory agencies. The incumbent will also support other key CalOptima Health staff on related projects. Position Information: 
<ul>
<li>Department: OOC - MediCal Regulatory Affairs &amp; Compliance </li>
<li>Salary Grade: 311 - $77,863 - $124,581 ($37.43 - $59.8947) </li>
<li>Work Arrangement: Full Telework **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>85% - Program Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Works with all of CalOptima Health's departments in response to inquiries, problem-solving and promoting CalOptima Health's mission and message.</li>
<li>Assists in the management of CalOptima Health's daily relationship with the DHCS for CalOptima Health's Medi-Cal program.</li>
<li>Maintains open lines of communication to ensure the ongoing trust and confidence of regulators in the program and management.</li>
<li>Researches, analyzes and makes recommendations regarding the policy implications of major initiatives for CalOptima Health's Medi-Cal program, e.g., integration of new benefits and populations.</li>
<li>Works with business areas at all levels of leadership to validate regulatory communications from regulators impacting CalOptima Health's Medi-Cal program.</li>
<li>Supports process improvements for the Office of Compliance department.</li>
<li>Serves as a Medi-Cal regulatory subject matter expert and lead for CalOptima Health's compliance issues and investigations.</li>
<li>Supports management in the readiness, coordination, oversight and remediation of regulatory audits, including but not limited to validating business area submissions, additional audit requests and written daily reports.</li>
<li>Researches and responds in a professional manner to questions pertaining to the Medi-Cal program.</li>
<li>Works with the director and manager with interactions and responses to regulatory representatives on compliance-related issues as needed.</li>
<li>Reviews and retains working knowledge of Medi-Cal policies and procedures related to assigned programs and projects.</li>
<li>Assists in the creation of communications and strategic alliances with regulators.</li>
<li>Researches and keeps current on the local, state and federal health care environment and health policy, identifying issues that may impact CalOptima Health's Medi-Cal program.</li>
<li>Coordinates the maintenance of public program benefit updates for accurate and consistent application by CalOptima Health and its provider community.</li>
<li>Participates and represents CalOptima Health in meetings and calls with regulators and associations and summarizes key points and impact to CalOptima Health's Medi-Cal program as needed. </li>
<li>10% - Administrative Support</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Initiates, facilitates and promotes activities to foster compliance awareness and encourages the reporting of compliance issues within the organization and related entities. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned.</li>
</ul>
</li>
</ul>
 Minimum Qualifications: 
<ul>
<li>Bachelor's degree in health services administration, public health, public policy or a related field PLUS 4 years of experience in government, public or government affairs role in health care compliance or health plan requirements required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>Master's degree. </li>
<li>Experience working with regulatory agencies in California. </li>
<li>Experience with Medi-Cal regulatory requirements and/or compliance in the areas of Customer Service, Grievance &amp; Appeals, Quality Improvement, Case Management, Claims Administration and/or Utilization Management. </li>
<li>Certification in Healthcare Compliance (CHC) or other compliance related certifications such as Certified Compliance and Ethics Professional.</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>n/a</li>
</ul>
 Knowledge &amp; Abilities: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits &amp; Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the <a href="https://apptrkr.com/get_redirect.php?id=6296744&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is June 25, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6296744" target="_blank">https://jobs.caloptima.org/jobs/program-policy-analyst-sr-medi-cal-compliance-505-city-parkway-west-california-united-states</a> Copyright ©2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-c10c0223e159b943b7243c210753f920

Program/Policy Analyst Sr (Medi-Cal Compliance)

Director, Medicare Program Development (Director III) CalOptima CalOptima Health is seeking a highly motivated Director, Medicare Program Development (Director III) to join our team. The Director III (Medicare Program Development) will be responsible for leadership, plan management and operations of CalOptima Health's Medicare lines of business, including the Program of All Inclusive Care for the Elderly (PACE) health plan operations. The incumbent will provide direction to CalOptima Health's departments to ensure compliance with regulatory agencies such as the Centers for Medicare and Medicaid (CMS), Department of Health Care Services (DHCS) and Department of Managed Health Care (DMHC). The incumbent will collaborate with the Operations Management, Clinical Operations, Regulatory Relations and Finance departments, including but not limited to Customer Service, Grievance and Appeals, Medical Management, Provider Network Operations, Strategic Development, Compliance and Regulatory Affairs and subcontracted providers and health networks. The Director III will interact with all levels of CalOptima Health's staff, members, providers, regulatory agencies, advisory committees and representatives of other agencies as needed. Position Information: 
<ul>
<li>Department: Operations Management </li>
<li>Salary Grade: 322 - $192,386 - $307,817 ($92.49 - $147.9891) </li>
<li>Work Arrangement: Partial Telework **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>50% - Leadership Functions
<ul>
<li>Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department.</li>
<li>Hires, supervises, develops, counsels and reviews the performance of department staff.</li>
<li>Supports the development of reports and presentations to CalOptima Health's Board of Directors, as needed.</li>
<li>Utilizes matrix management, directs and coordinates staff throughout the organization in the implementation of strategic work plans, development and implementation of new benefits or other initiatives for health plan operations, including but not limited to CMS Five Star Program operational initiatives and improvement activities.</li>
<li>Ensures implementation of Medicare and PACE program changes to comply with CMS regulatory requirements and is responsible for communication with stakeholders to implement such changes.</li>
<li>Ensures timely filing and compliance with CMS reports and data submissions.</li>
<li>Reviews and recommends approval of OneCare program and PACE health plan operations policies and procedures by the Executive Director and executive leadership. </li>
</ul>
</li>
<li>45% - Program Oversight
<ul>
<li>Directs and leads all business operations associated with the Medicare lines of business operations and supports certain PACE health plan operations, including coordination with and oversight of delegated health networks, contracted providers and contracted vendors.</li>
<li>Directly leads Medicare Programs outreach and retention function including developing strategies designed to expand community outreach and retention of current OneCare members.</li>
<li>Reviews and monitors Medicare programs and PACE program financial performance, provides recommendations and develops action plans.</li>
<li>Develops and monitors strategies and tactics for business development, new member enrollment and member retention in Medicare and PACE programs.</li>
<li>Supports Medicare annual bid submissions, including project management, supplemental benefit development and coordination with external actuary firm(s) and internal departments to complete and submit bids on time for Medicare and PACE programs.</li>
<li>Oversees the development of strategic plans, work plans and other initiatives for the OneCare and PACE program health plan operations.</li>
<li>Collaborates with Finance and other departments to improve activities for Medicare Risk Adjustment Factor (RAF) improvement activities for applicable programs.</li>
<li>Collaborates with internal departments in the implementation and oversight of community and member outreach activities designed to maximize visibility of Medicare programs including OneCare and PACE.</li>
<li>Partners with staff from across the organization to research specific issues as necessary to develop and analyze solutions and make policy or programmatic recommendations to address operational issues.</li>
<li>Reviews reports for submission to CMS, CalOptima Health's Board of Directors, executive leadership and others, as needed.</li>
<li>Facilitates monthly operations meetings to review Medicare and PACE program medical, financial and administrative operations.</li>
<li>Communicates the plan's operational issues, ensures adherence to work plans, identifies problem areas and develops solutions to issues or problems.</li>
<li>Collaborates with Medicare Programs Sales and Marketing and Communications departments in the development of marketing and enrollment strategies and tactics for increasing Medicare and PACE program enrollment and retention. </li>
</ul>
</li>
<li>5% - Completes other projects and duties as assigned. </li>
</ul>
 Minimum Qualifications: 
<ul>
<li>Bachelor's degree in business administration or related field PLUS 7 years of experience in a management position of a health insurance plan, Independent Physician Association (IPA), managed care organization or public agency serving Medicare and Medicaid (Medi-Cal) populations required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>7 years of progressive leadership experience, including direct supervision of staff required.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>Master's degree. </li>
<li>Medicare Advantage health plan operations, Medicare Advantage health maintenance organization (HMO) special needs plans (SNP), Medicaid or Medi-Cal and PACE program operations experience. </li>
<li>Project management experience.</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>N/A</li>
</ul>
 Knowledge &amp; Abilities: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits &amp; Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the <a href="https://apptrkr.com/get_redirect.php?id=6281703&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is June 20, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6281703" target="_blank">https://jobs.caloptima.org/jobs/director-medicare-program-development-director-iii-505-city-parkway-west-california-united-states</a> Copyright ©2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-7afb9ea777e68d4fab491cabeb4bb238

Director, Medicare Program Development (Director III)

TITLE: &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;ChiefTalent Officer
LOCATION: &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp; &nbsp; &nbsp;New York, NY (Lower EastSide)
DEPARTMENT: &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;Administration/Human Resources
REPORTS TO:&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp; &nbsp; Chief Executive Officer (CEO)
SALARY RANGE: &nbsp; &nbsp; &nbsp;&nbsp;&nbsp;$175,000 to $200,000 annually depending onexperience, plus excellent benefits
DATE POSTED: &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;July 2024

OUR CULTURE:&nbsp; At Grand St. we believeleaders are made, not born. &nbsp;We operate on auto trust,expecting staff will do their jobs well and continue to growprofessionally. &nbsp; We assume the best intentions and give gracewhenever needed. &nbsp; Diversity, equity, and inclusion areintegral parts of our culture and personified by our leadership.Grand St. is a community and we strive to make everyone –colleagues and constituents – feel supported and seen. &nbsp;
JOB SUMMARY:&nbsp; The Chief Talent Officer(CTO) provides executive-level leadership and guidance to theorganization’s HR strategies and operations for 600+ Union andManagement staff. The CTO is responsible not only for setting,enforcing, and evaluating legally compliant human resourcespolicies, procedures, and best practices, but also identifying andimplementing long-range strategic talent management goals. You willwork closely with the Executive Team performing all facets ofHR-related duties partnering with the Chief Financial Officer(CFO), Chief Program Officer of Youth &amp; Community Development,Chief Operating Officer (COO), Chief Development &amp;Communications Officer (CDCO), as well as senior management staff.&nbsp;This position carries out responsibilities in the followingfunctional and strategic areas: benefits administration, employeerelations, labor relations, training, performance management,onboarding, policy implementation, recruitment/employment,affirmative action and employment law compliance.&nbsp;
EDUCATION, EXPERIENCE AND SKILLREQUIREMENTS:
<ul>
<li>Masters preferred</li>
<li>Minimum of 10 years of Human Resource Management experiencerequired&nbsp;</li>
<li>HR Certification preferred</li>
<li>Strategic, Talent Management and/or Business Developmentexperience preferred</li>
<li>Knowledge of proven and emerging techniques in all aspects ofpersonnel management</li>
<li>Strong communication skills (both verbal and written)</li>
</ul>
<ul>
<li>Excellent supervisory, leadership, interpersonal and conflictresolution skills</li>
<li>Excellent organizational skills</li>
<li>Strong analytical and problem-solving skills</li>
<li>Thorough knowledge of employment-related laws andregulations</li>
<li>Experience with development and implementation of humanresource information and payroll systems</li>
<li>&nbsp;Experience with labor relations in a unionizedenvironment</li>
</ul>
Supervisory Responsibilities:
<ul>
<li>Supervises Management-level HR and Payroll staff</li>
<li>Oversees the daily workflow of the HR department and theadministration of human resource programs including, but notlimited to, compensation, benefits and leaves, disciplinarymatters, disputes and investigations, performance &amp; talentmanagement, evaluations, recognition, morale, occupational healthand safety, and training and development</li>
</ul>
ESSENTIAL DUTIES AND RESPONSIBILITIES:
<ul>
<li>Partners with the Executive Team to develop, implement andcommunicate human resource policies, procedures, laws, standardsand government regulations</li>
<li>Maintains the Employee Handbook</li>
</ul>
<ul>
<li>Collaborates with executive leadership to definethe&nbsp;organization's&nbsp;long-term mission and goals;identifies ways to support this mission through talentmanagement</li>
<li>Identifies key performance indicators (KPI’s) forthe&nbsp;organization's&nbsp;human resource and talent managementfunctions and assesses the&nbsp;organization's&nbsp;success andmarket competitiveness based on those metrics</li>
<li>Researches, develops, and implements competitive compensation,benefits, performance appraisal, and employee incentiveprograms</li>
<li>Oversees benefits administration including claims resolution,change reporting, approval of invoice payment, and communicatingbenefit&nbsp;information to employees</li>
<li>Ensures compliance with employment benefits, insurance, safety,401K, EEOC and other labor laws, regulations, and requirements</li>
</ul>
<ul>
<li>Administers and manages the 401K Plan</li>
</ul>
<ul>
<li>Maintains knowledge of laws, regulations, and best practices inemployment law, human resources, compensation and talentmanagement</li>
<li>Drafts and implements the&nbsp;organization's&nbsp;staffingbudget for the department.</li>
<li>Participates in professional development and networkingconferences and events.</li>
</ul>
<ul>
<li>Oversees department’s recruitment efforts including the postingof positions, recruitment advertising and other outreachpartnerships</li>
</ul>
<ul>
<li>Handles labor relations matters and coordination of thegrievance process</li>
</ul>
<ul>
<li>Monitors unemployment claims and assists with appeals onworkers’ compensation claims and coordinates between the employeeand insurance carrier</li>
<li>Responsible for Workers Compensation and 401k Audits</li>
<li>Performs other duties as required and assigned.</li>
</ul>
&nbsp;Your Skills &amp;Knowledge&nbsp;
<ul>
<li>Build a strong organizational culture that aligns with GrandStreet Settlement mission and implements all of those values onevery level of the organization</li>
<li>You take ownership of your work, think strategically, and takethoughtful action with very little direction</li>
<li>Excellent verbal and written communication skills</li>
<li>Excellent analytical and organizational skills</li>
<li>Extremely proficient with Microsoft Office Suite, Google Suiteor related software</li>
<li>People-centric and contributes to Grand St. Settlement’slegacy</li>
</ul>
BENEFITS:
<ul>
<li>Full medical insurance coverage</li>
<li>9% employer contribution to our 401k plan after 1 year</li>
<li>24 vacation days annually, 4 discretionary days, 12 sick daysannually</li>
<li>Guaranteed life Insurance and long-term disabilityinsurance</li>
<li>Flexible spending accounts</li>
<li>Travel/ commute reimbursement</li>
</ul>
HOW TO APPLY:
Please submit a resume and thoughtful cover letter outlining howyour skills &amp; experience meet the job descriptionto&nbsp;<a href="mailto:ctosearch@grandsettlement.org" target="_blank">ctosearch@grandsettlement.org</a>.Please include three professional references that we can contact;at least one should be a former supervisor.&nbsp;
If selected for this position, must obtain NYC Dept.of Health fingerprint clearance and State Central Registry (SCR)clearance (fees may apply); ability to maintain State CentralRegistry (SCR) clearance and fingerprint clearance throughout theduration of employment.
Employment Opportunity Employer (EOE)&nbsp;

Chief Talent Officer

<h3>Job Description</h3>
Job Description
Grievance and Appeals Coordinator CalOptima $28-31/HR Orange CA - 92868 Duties &amp; Responsibilities: 95% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Maintains adequate information in CalOptima Health’s systems; ensures data collection, summarization, integration and reporting which includes case creation and management and events/activity tracking. Gathers pertinent information regarding the grievances and appeals received, including member or provider concerns, supporting information related to initial decision-making, new information supporting the grievance or appeal or supplemental information required to evaluate grievances and appeals within regulatory requirements. Coordinates and participates in case discussions with operational experts to result in a final case disposition as needed. Evaluates case details, proposes recommendations or makes decisions as applicable and ensures the organization’s decision is implemented according to the Grievance and Appeals policies and case resolution. Develops resolution letters and correspondence to members and providers. Communicates with internal and external customers to ensure timely review and resolution of grievances or appeals. Contacts appropriate parties to request and obtain missing information and supporting documentation or provides education. Reads and interprets provider contracts, Division of Financial Responsibility (DOFR), policies, procedures and instructions. Responds to routine provider inquiries via phone, assisting with provider appeals resolution inquiries. Assists with the health networks’ compliance process. Identifies trends and root causes of issues, proposes solutions or escalates ongoing issues to management. Meets performance measurement goals for Grievance and Appeals Resolution Services. 5% - Completes other projects and duties as assigned. Minimum Qualifications: High school diploma or equivalent PLUS 1 year of experience with Provider Dispute Resolution (PDR) in Medicare and Medi-Cal in professional, institutional, outpatient, ancillary, coordination of benefits and government cases required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. 1 year of experience with Medicare or Medi-Cal provider appeals and denials process required. 1 year of experience in any of the following areas: Grievances and Appeals, Claims Administration, Regulatory Compliance, Customer Service or related field required. Preferred Qualifications: Associate degree in business, health care administration or related field. Experience in health care practice standards, for both government and commercial plans. Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese). Required Licensure / Certifications: N/A Knowledge &amp; Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. &nbsp;
Company DescriptionIT Mantra, LLC. is a Certified Woman / Minority (WBE/MBE) owned company founded in 2003 and based in Massachusetts. We provide a comprehensive range of IT and Professional Staffing and Workforce Solutions that include contract, contract to hire and direct hire placement services as well Employer of Record (EOR) services nationally and specialize in the placement of women and diverse personnel. 
<h3>Company Description</h3>
IT Mantra, LLC. is a Certified Woman / Minority (WBE/MBE) owned company founded in 2003 and based in Massachusetts. We provide a comprehensive range of IT and Professional Staffing and Workforce Solutions that include contract, contract to hire and direct hire placement services as well Employer of Record (EOR) services nationally and specialize in the placement of women and diverse personnel.

Grievance and Appeals Coordinator

<h3>Job Description</h3>
Job DescriptionDescription:
 
Purpose:
The Student Services Advisor is responsible for the overall support of the Student Services Department providing day-to-day support and direction with respect to policies, practices, systems and community support. The Student Services Advisor supports the Student Services department with respect to scheduling and work assignments, Title IX compliance, ADA coordination, student complaints, grievances, appeals and performing other duties as required. The Student Services Advisor contributes to the College’s success by providing input into the development of the campus’ strategic and operational plans, and by ensuring that the campus achieves its student engagement, retention, and completion goals in a student centric campus environment. Responsible for taking a leadership role in cultivating and creating Smith Chason College campus spirit and pride.
 
Qualifications:
<ul>
<li>Bachelor’s degree preferred. Acceptable experience includes at minimum, 2-3 years of administrative experience. Recommended competencies include:</li>
<li>Must have strong technical skills including all computer applications, internet research, database management, and analytical skills.</li>
<li>Ability to prioritize, multi-task, perform well under pressure, meet deadlines, and work flexible schedule. </li>
<li>Ability to communicate with high level industry supervisors and management teams. </li>
<li>Strong ability to work independently as well as collaboratively with other team members. </li>
<li>Ability to engage in critical thought and analyze all types of quantitative and qualitative data into reports and presentation for strategic planning and problem-solving.</li>
<li>Ability to provide support and ensure accountability for results.</li>
<li>Strong organizational skills.</li>
<li>Effective time management skills; ability to separate important issues and identify priorities.</li>
<li>Ability to track, monitor, assess and evaluate student progress and registry outcomes.</li>
<li>Possesses strong motivational skills, oral and written communication proficiency.</li>
<li>Provide excellent customer service to all members of the WCUI community.</li>
<li>Must have strong documentation skills.</li>
<li>Demonstrates integrity, credibility, confidentiality, and responsibility in all interactions.</li>
<li>Possesses high ethical standards and an honest, open, and consistent approach to working with peers, employees, employers and staff.</li>
<li>Individuals must be professional in all aspects of the position including appearance, demeanor, communication and attitude.</li>
</ul>
Reports to:
Senior Student Services Manager
 
Responsibilities:
<ul>
<li>Represent and support the Department of Student Services, ensure safety of students, regulatory compliance, consistency of practice and excellent student/customer service </li>
<li>Manage the Department’s work with faculty and staff, colleagues, students and community partners to support, provide and/or facilitate activities that ensure that the campus achieves its student engagement, satisfaction, retention, and completion goals </li>
<li>Provide analysis and advisement in relation to policies, procedures, and operational plans regarding students and services for students, including risk management. </li>
<li>Monitor, manage and enforce Satisfactory Academic Progress and Attendance Policies </li>
<li>Provide support with Title IX compliance</li>
<li>Work with the ADA Compliance Coordinator to facilitate all communication for requests for accommodations, ensure approved accommodations are communicated and managed and support students with the grievance process </li>
<li>Address complaints and conducts investigations as directed by the Senior Student Services Manager</li>
<li>Ensure that Student Services Department monitors students’ attendance and academic performance on a weekly basis, progress toward program completion, providing or recommending interventions as needed </li>
<li>Ensure the Student Services Department maintains appropriate documentation with regards to advising sessions including meeting overviews, progress notes, referrals, and follow-up activities. </li>
<li>Ensure that the Student Services Department follows all regulatory bodies </li>
<li>Lead in the developing and conducting of student events including but not limited to orientation, community outreach, graduation and student appreciation </li>
<li>Maintain knowledge of Smith Chason College programs, campus resources, information systems, and policies and procedures </li>
<li>Additional job-related duties as required and assigned</li>
</ul>
 
PHYSICAL REQUIREMENTS/ WORKING CONDITIONS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
<ul>
<li>Must be able to remain in a stationary position for prolonged periods of time</li>
<li>Can independently move objects up to 25 lbs.</li>
<li>Sufficient hand, arm, and finger dexterity to operate a computer keyboard, other office machinery, and perform repetitive motions</li>
<li>Must have sufficient hearing and speaking ability to communicate in person or on the phone/computer with others</li>
<li>Must be able to occasionally function in activities that include walking, bending, squatting, and reaching</li>
</ul>
 
CULTURE OF CARE
Culture of Care is our commitment to create a supportive environment in which every student can achieve their educational and career goals. Culture of Care encourages one-on-one relationships. Creating a culture that focuses on the student and their wellness. This includes understanding the student's complex lives. It is about creating a school where everyone feels welcomed by: 
· Creating a sense of community in all interactions and communications with students 
· Identifying problem areas and offering assistance 
· Opening up safe conversations for cooperative solutions 
· Holding students to standards and goals that will ultimately make them successful in their careers
 
Requirements:

Student Services Advisor

<h3>Job Description</h3>
Job Description
As an Appeals and Grievances Coordinator you'll play a crucial role in efficiently processing appeal and grievance requests, ensuring smooth operations, and maintaining excellent communication.
Responsibilities:
<ul>
<li>Support the team in processing appeal and grievance requests promptly and efficiently.</li>
<li>Communicate effectively with the team about special projects and priorities.</li>
<li>Monitor and distribute incoming faxes and emails to the appropriate departments.</li>
<li>Review and prioritize written appeals and grievances.</li>
<li>Enter and document new appeals or grievances received via various channels.</li>
<li>Assist in obtaining additional information and follow-up as needed.</li>
<li>Maintain accurate documentation of all communications and actions.</li>
<li>Coordinate meetings, including scheduling, invites, agendas, and minutes.</li>
<li>Provide administrative support to the Appeals and Grievances Supervisor and Utilization Operations Director.</li>
</ul>
Qualifications:
<ul>
<li>High School Diploma.</li>
<li>6 months of experience in an administrative role.</li>
<li>1 year of experience in a customer service role.</li>
<li>Previous experience in the healthcare industry and with Facets and Salesforce is a plus.</li>
<li>Intermediate computer skills, including email, database activity, word processing, and spreadsheets.</li>
</ul>
Sacramento, CA 95833 Monday to Friday 8am - 5pm
potential to go hybrid
3+ contract covering for a leave
 Pay Details: $20.00 to $23.00 per hour Search managed by: Joanna Calderon Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable. Equal Opportunity Employer/Veterans/Disabled To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to <a href="https://www.lhh.com/us/en/candidate-privacy" target="_blank">https://www.lhh.com/us/en/candidate-privacy</a> The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable: 
<ul>
<li>The California Fair Chance Act</li>
<li>Los Angeles City Fair Chance Ordinance</li>
<li>Los Angeles County Fair Chance Ordinance for Employers</li>
<li>San Francisco Fair Chance Ordinance</li>
</ul>

Appeals and Grievance Specialist

<h3>Job Description</h3>
Job Description
Capital University is committed to fostering a campus environment free from sexual harassment and discrimination and does not discriminate against students, faculty or staff based on sex in any of its programs or activities, including but not limited to educational programs, employment, and admission. Working with campus partners, the Title IX Coordinator will lead the university's efforts to foster a living, working and education environment that is free from harassment, discrimination, and sexual misconduct through prevention and education efforts as well as ensuring a fair, impartial process for all individuals involved in a Title IX investigative process. The Title IX Coordinator has primary responsibility for coordinating and implementing Capital University's Title IX compliance efforts, across its two campuses in Bexley and Columbus, Ohio, respectively. The Title IX Coordinator will work closely with campus partners to facilitate a fair and equitable conduct process for all who are involved in the process.
 
As Title IX Coordinator, this individual is responsible for managing the day-to-day responsibilities associated with the University's obligations under Title IX of the Education Amendments of the 1972 Civil Rights Act and the Clery Act, as amended by the Violence Against Women Act.
 
Primary roles and responsibilities: 
<ul>
<li>Complaint Process Management: Coordinate the prompt, effective, and equitable intake, investigation, and timely resolution of all allegations of sex or gender-based discrimination, harassment, and retaliation, pursuant to applicable state law, federal law, and university policy; Ensure that investigation findings and outcomes are consistent with applicable regulations and are properly documented; Collaborate with outside professional partners to assign investigators, decision-makers, and hearing advisors for Formal Complaints; Conduct Informal Resolution processes and Formal Hearings; Coordinate supportive measures for Complainants and Respondents in Title IX processes; Oversees sanction completion and maintains Informal Resolution and Supportive Measure accommodations. Selects, trains, and designates Deputy Title IX Coordinator(s) and Investigative team across critical areas of the institution to ensure all involved with processing Title IX complaints are adequately trained in compliance with Title IX guidance.</li>
</ul>
 
<ul>
<li>Policy Compliance: Ensures ongoing compliance with Title IX by collecting and analyzing data, writing comprehensive reports and maintaining records of investigations.; Act as the point of contact for campus community, governmental agencies, and members of the public regarding information or concerns regarding sex or gender-based discrimination, including sexual misconduct. Serves as point of contact for Ohio Department of Higher Education and Changing Campus Culture initiative; Implements and regularly reviews policies and procedures that meet all relevant legal requirements; Provide Clery reportable incidents to the Clery Report and Annual Safety Report; Maintain a comprehensive case management system that organizes, manages, and tracks all reports and preserves other Title IX documentation as required by law; Fulfill governmental reporting responsibilities; Oversee protocols for campus responses to data requests from internal and external constituents and agencies; Remain current regarding state and federal law, including but not limited to Title VII, Title IX, VAWA, Campus Save Act, Clery Act, and FERPA; Develop, implement, and review policies, procedures, and grievance procedures as they relate to Title IX, sex or gender-based discrimination, sex harassment, and sexual and relationship violence. Remain current regarding trends in the field of education related to sex or gender-based discrimination and sexual misconduct.</li>
</ul>
 
<ul>
<li>Prevention and Education: Develop and implement long-term goals for programming, services, education, and assessment of Title IX compliance efforts; Select, train, and oversee designated Title IX Investigators across critical areas of the institution; ensure investigator, adjudicator, and those involved with processing Title IX complaints are adequately trained in compliance with Title IX guidance; Provide Title IX compliant training to investigators, decision makers, and facilitators of informal resolutions and ensure that all new hires, employees and students receive annual Title IX training; Provide students, faculty, and staff with information regarding the university complaint process, available resources, supportive measures, and reporting and resolution options; Leads the development and/or implementation of University climate surveys pertaining to sexual misconduct, sexual harassment, domestic violence, dating violence, and/or stalking; Monitors and maintains the College's Title IX webpage and materials; Meet regularly with key constituencies regarding shared concerns (e.g. Fraternity and Sorority Life organization leadership councils, athletics, Residential and Commuter Life, etc.); Maintains and updates informational and outreach materials regarding Title IX and sexual relationship violence, including a webpage. Participate in the Wellness and Prevention Team to coordinate programming.</li>
</ul>
 
<ul>
<li>Support in other University processes: Serve as a hearing, appeals or investigative officer in other university processes including but not Anti-Hazing, Bias Response, Student Conduct, and Accessibility Services.</li>
</ul>
 
Qualifications: 
<ul>
<li>Master's degree with at least two years of relevant experience required. J.D., PhD, or EdD Preferred. </li>
<li>Ability to understand, communicate with and effectively interact with people across cultures. Possesses a positive attitude towards cultural differences. Willing to gain knowledge of different cultural practices and world views and determine how those practices and views will factor in during investigations, complaints, reports, findings, etc.</li>
<li>To perform this job successfully, an individual should have prior experience in: Maxient, Microsoft Word, Excel, Access, PowerPoint, Outlook, and Social Media Sites (Facebook/Twitter).</li>
<li>Ability to respond to common inquiries or complaints from students, employees, customers, regulatory agencies, or members of the business community. Ability to write investigation reports, speeches and articles for publication that conform to prescribed style and format. Ability to effectively present information to top management, public groups, and/or boards of directors.</li>
<li>This position requires the ability and/or skill to collaborate and work closely and professionally with others as part of a team regardless of race, gender, sexual orientation, etc.; be flexible; have attention to detail; work without supervision, a demonstrate initiative; communicate professionally through both verbal and written means; manage multiple priorities under tight deadlines; establish departmental goals and priorities; and contribute to Capital University's philosophy, diversity and inclusion initiatives, strategic plan, goals, and doctrine.</li>
<li>Ability to facilitate discussion groups and workshops; ability to coordinate events; ability to update and maintain social media presence and organizational listservs.</li>
</ul>
 
Applicants must submit resume and cover letters.
 
For more information on Capital University, visit our website at <a href="http://www.capital.edu" target="_blank">www.capital.edu</a>.
 
Capital University offers a rich benefits package that includes medical, dental, vision, retirement, family education benefits, short-term and long-term disability, life insurance and free parking. 
 
Capital University is an equal opportunity employer. Capital University does not discriminate on the basis of race, color, national or ethnic origin, sexual orientation, religion, sex, gender, age, disability, veteran status, or other characteristics protected by the law.
 Job Posted by ApplicantPro

Title IX Coordinator

<h3>Job Description</h3>
Job DescriptionOverview: TekWissen is a global workforce management provider headquartered in Ann Arbor, Michigan that offers strategic talent solutions to our clients world-wide. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family, dental and vision, plans for employers, etc. Title: Grievance &amp;Appeals CoordinatorWork Location: Detroit, MI, 48226Duration: 6 Months Job Type: ContractWork Type: RemoteDept: 126160Engagement Description:
<ul>
<li>Process appeals and grievances, analyse, research, and provide comprehensive responses in accordance with established regulatory and accreditation guidelines. </li>
<li>Contact customers to gather information and communicate disposition of case. </li>
<li>Conduct pertinent research in order to evaluate, respond to, and finalize case. </li>
<li>Familiar with standard concepts, practices, and procedures for analysing, interpreting data and applying contract and regulatory provisions. </li>
<li>High School Diploma or GED required. </li>
<li>Bachelor's Degree in English, Communications or related field preferred. </li>
<li>Two (2) years customer service experience required. </li>
<li>Two (2) years health insurance experience and familiarity with health insurance state and federal regulations preferred. </li>
<li>Strong project management skills preferred. </li>
</ul>
Top 3 Required Skills/Experience 
<ul>
<li>Experience handling a large load of work in a fast-paced environment and have computer skills! </li>
<li>Insurance, Medicare/CMS knowledge </li>
<li>Customer Service Experience </li>
</ul>
Required Skills/Experience The rest of the required skills/experience. Include: 
<ul>
<li>Writing Letters </li>
<li>Analytical thinker </li>
<li>Research Skills </li>
<li>Multi-task </li>
</ul>
Preferred Skills/Experience Optional but preferred skills/experience. Include: 
<ul>
<li>Grievance and Appeals experience. </li>
<li>Degree in Healthcare/computer skills </li>
<li>Experience in analyzing a claim </li>
<li>Experience in classification between a grievance/appeal/organizational determination. </li>
<li>Letter writing </li>
<li>Basic computer skills. How to save a PDF, how to navigate excel, learning new systems </li>
</ul>
Education/Certifications Include: 
<ul>
<li>Healthcare, English</li>
</ul>
TekWissen Group is an equal opportunity employer supporting workforce diversity.

Grievance &Appeals Coordinator

<h3>Job Description</h3>
Job Description
Job Title: Grievance &amp;Appeals Coordinator
Location: Remote
Duration 6+ months
Dept: MA Grievances and Appeal Will this position be required to work onsite for any reason at any time? No, fully remote Engagement Description – Process appeals and grievances, analyze, research, and provide comprehensive responses in accordance with established regulatory and accreditation guidelines. Contact customers to gather information and communicate disposition of case. Conduct pertinent research in order to evaluate, respond to, and finalize case. Familiar with standard concepts, practices, and procedures for analyzing, interpreting data and applying contract and regulatory provisions.
 Top 3 Required Skills/Experience – • Experience handling a large load of work in a fast-paced environment and have computer skills! • Insurance, Medicare/CMS knowledge • Customer Service Experience Required Skills/Experience – The rest of the required skills/experience. Include: • Writing Letters • Analytical thinker • Research Skills • Multi-task Preferred Skills/Experience – Optional but preferred skills/experience. Include: • Grievance and Appeals experience. • Degree in Healthcare/computer skills • Experience in analyzing a claim • Experience in classification between a grievance/appeal/organizational determination. • Letter writing • Basic computer skills. How to save a PDF, how to navigate excel, learning new systems Education/Certifications – Include: • Healthcare, English
High School Diploma or GED required. Bachelor's Degree in English, Communications or related field preferred. Two (2) years customer service experience required. Two (2) years health insurance experience and familiarity with health insurance state and federal regulations preferred. Strong project management skills preferred.
Company DescriptionFounded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances. At Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development. Kyyba is an Equal Opportunity Employer. Kyyba does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other b 
<h3>Company Description</h3>
Founded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances.\r\n\r\nAt Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development.\r\n\r\nKyyba is an Equal Opportunity Employer.\r\n\r\nKyyba does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other b

Grievance & Appeals Coordinator

<h3>Job Description</h3>
Job Description
Hi All,
My name is Poornachandra Rao and I'm a recruiter at Kyyba. We specialize in recruiting professionals at all levels (both contract and perm). I came across your profile and believe you are a great fit for one of the opportunities. I've included the job description here for your review. Please let me know if you’re interested and like to discuss this opportunity in greater detail. You can reach me at (248) 254 4299
Fully Remote- Mostly C2H after Contract based on the performance

Job Title : . Grievance &amp;Appeals Coordinator
No of Positions : 08
Duration : 6+Months (C2H)
Must have : Our G&amp;A Coordinators handle each case from start to finish, conducting all research, analysis, making the final determination, and drafting a response letter.&nbsp; Individuals must be able to formulate free form letters that take complex issues and explain them in a clear and simple manner.&nbsp;
Engagement Description – Process appeals and grievances, analyse, research, and provide comprehensive responses in accordance with established regulatory and accreditation guidelines. Contact customers to gather information and communicate disposition of case. Conduct pertinent research in order to evaluate, respond to, and finalize case. Familiar with standard concepts, practices, and procedures for analysing, interpreting data and applying contract and regulatory provisions. High School Diploma or GED required. Bachelor's Degree in English, Communications or related field preferred. Two (2) years customer service experience required. Two (2) years health insurance experience and familiarity with health insurance state and federal regulations preferred. Strong project management skills preferred. Top 3 Required Skills/Experience – • Experience handling a large load of work in a fast-paced environment and have computer skills! • Insurance, Medicare/CMS knowledge • Customer Service Experience Required Skills/Experience – The rest of the required skills/experience. Include: • Writing Letters • Analytical thinker • Research Skills • Multi-task Preferred Skills/Experience – Optional but preferred skills/experience. Include: • Grievance and Appeals experience. • Degree in Healthcare/computer skills • Experience in analysing a claim • Experience in classification between a grievance/appeal/organizational determination. • Letter writing • Basic computer skills. How to save a PDF, how to navigate excel, learning new systems Education/Certifications – Include: • Healthcare, English,
Company DescriptionFounded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances. At Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development. Kyyba is an Equal Opportunity Employer. Kyyba does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other b 
<h3>Company Description</h3>
Founded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances.\r\n\r\nAt Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development.\r\n\r\nKyyba is an Equal Opportunity Employer.\r\n\r\nKyyba does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other b

13 grievance-and-appeals-coordinator Jobs