Vice President Of Appeals And Grievances 3093007 I.Html

Providing strategic leadership in a fully remote capacity, the Vice President of Appeals and Grievances will manage the operational, regulatory, and performance aspects of provider and member appeals, ensuring compliance with CMS regulations and driving organizational excellence.

##### Key Responsibilities

Develop and maintain the strategic roadmap for the appeals program, ensuring compliance with Medicare Advantage regulations

Oversee daily operations of appeals and grievance processes, ensuring timely resolution within mandated timeframes

Serve as the primary organizational representative to CMS and regulatory bodies regarding appeals and grievances performance

##### Required Qualifications

10+ years of leadership experience in appeals, grievances, or health plan regulatory operations, with at least 5 years in a senior leadership role

Deep understanding of CMS Medicare Advantage Part C requirements and appeal decision standards

Bachelor's degree in Healthcare Administration, Business, or a related field

Strong experience in case review and writing defensible rationales for medical necessity determinations

Exceptional leadership and cross-functional collaboration skills