Director of Grievance and Appeals

Job Title: Director Grievance and Appeals
Location: Rancho Cucamonga, CA

Morgan Consulting Resources, Inc. has been retained to conduct the search for the Director of Grievance and Appeals for Inland Empire Health Plan. This position is located in Rancho Cucamonga, CA.

About the organization:

Inland Empire Health Plan (IEHP) is one of the largest not-for-profit health plans in California. They serve over 1.2 million members in Riverside and San Bernardino counties through government sponsored programs including Medi-Cal (California’s Medicaid Plan) and the Cal MediConnect Plan (Medicare-Medicaid Plan).

IEHP’s mission is to organize and improve the delivery of quality, accessible and wellness based healthcare services for their community. Their core values include:

  • Health and Quality before Costs: they believe in placing members’ health care needs above all else.
  • Team Culture: they are a dedicated and cohesive team focused on member care and supporting their providers.
  • Think and Work LEAN: they strive to continuously improve their daily operations and delivery of healthcare services.
  • Partner with Providers: they recognize the necessity of a strong working relationship with their providers – based on mutual respect and collaboration.
  • Stewardship of Public Funds: they are accountable to the public and strive for transparency and prudent fiscal management.

For more information about the organization, please visit: https://ww3.iehp.org/.

About the Director of Grievance and Appeals:

Reporting to the Executive Director of Health Services Operations, the Director of Grievance and Appeals will oversee a staff of 95 with the following direct reports: three managers and seven supervisors. We are looking for a Director with strong grievance and appeals experience and the ability to foster collaborative relationships vertically and horizontally across the organization. Additionally, candidates who have a strong focus on mission/values are ideal for this position.

The Director will lead the department in meeting turnaround metrics and interfacing with CMS on audits. He or she will be involved in issue identification and resolution. Medi-Cal experience highly preferred.

Major goals and projects:

  • Implementation of State audit findings in the department;
  • Manage the “All Plan Letters” as outlined by the State;
  • Prepare for anticipated CMS audit early 2019.

Minimum qualifications:

Education/Licensure:

  • Possession of a valid clinical license issued by the State of California required. Clinical licensure requirement can be met via: Physician Assistant (PA, PA-C), Nurse Practitioner (NP), Family Nurse Practitioner (FNP), Adult Nurse Practitioner (ANP), Pharmacist (PharmD), or Registered Nurse (RN).
  • Bachelor’s degree in a health-related field from an accredited four-year institution preferred.
  • Valid State of California driver’s license.

Experience, Knowledge, Skills and Abilities:

  • A minimum of two years’ experience leading healthcare utilization management or care management teams required.
  • Four or more years’ experience in quality assurance, utilization management, case management, and/or provider liaison duties, preferably in an HMO or Managed Care setting.
  • Two or more years’ experience working in a clinical setting required.
  • Strong knowledge of State of California and Federal grievance and appeal regulations.
  • Excellent written and verbal communication skills that adapt to targeted audience.
  • Strong team leadership skills.
  • Ability to demonstrate critical thinking, strong problem solving capability.
  • Strong attention to detail.
  • Positive attitude and ability to develop teams that are productive, adaptive and collaborative.

If someone you know has the qualifications we seek, we’d love to set up a time to talk!

Kim Phillips, Executive Recruiter/Search Consultant
Morgan Consulting Resources, Inc.
Kim@morganconsulting.com

Rosie Saenz, Executive Recruiter/Search Consultant
Morgan Consulting Resources, Inc.
rosie@morganconsulting.com

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