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Director of Appeals, Complaints, And Grievances
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- Reporting to the Chief Medical Officer, the Director of Complaints, Grievances, and Appeals (CG&A) is responsible for directing CG&A operations, providing leadership and oversight for all lines of business.
- The Director will oversee key CG&A functions including the processing of member appeals, provider appeals, and payment disputes.
- They ensure JHHC maintains the highest possible standards of quality and operational compliance in line with JHHC’s strategic goals, accreditation, regulatory, and CMS STARS rating measures.
- The Director will serve as primary contact for state regulatory agencies and consumer advocacy agencies regarding member CG&A issues.
- Work requires knowledge of the health field and managed care case management/utilization management processes as acquired during five years of related experience with at least five years of management responsibilities.
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