Director, Regulatory/Grievances & Appeals

Description SHIFT: Day JobSCHEDULE: Full-timeResponsible for planning, organizing, directing and evaluating the investigation, resolution, and response to client grievances/appeals and ensuring regulatory compliance requirements are met.Responsible for liaising with the Department of Managed Health Care, California Department of Insurance, and other regulatory agencies.This role will act in the official capacity of the California Grievance Officer.Primary duties may include, but are not limited to: Develops operational budget as well as manages the departmental budget.

Maintains and coordinates staff activities so as to achieve departmental and corporate company goals in improving service to customers and assuring regulatory compliance.

Manage team performance and productivity to ensure timely and quality responses to grievances and appeals and ensure all contractual requirements and regulatory compliance is met

Responsible for analysis and development of strategies by achieving performance thresholds within budgetary guidelines.

Ensures that programs supports overall QI program and meets regulatory compliance/accreditation and Company standards.

Provides quality control services by monitoring work results of direct reports and directing these activities for department.

Performs audits to monitor efficiency and compliance with policies.

Identifies and ensures the delivery of associate training.

Hires, trains, coaches, counsels, and evaluates performance of direct reports and directs these activities for department.

Qualifications Requires a BA/BS degree and 7 years leadership experience; or any combination of education and experience, which would provide an equivalent background.

Strong problem solving and decision making skills

Strong oral, written and interpersonal communication skills

Attention to detail

Ability to travel when needed (minimal up to 15%)

Preferred: Experience in Operations or production environment

Healthcare audit/compliance experience

Regulatory experience

Experience working at all levels of the organization, including senior level management

AnEqualOpportunityEmployer/Disability/VeteranREQNUMBER: PS40587-US