Supervisor, Grievances

The supervisor, grievances is responsible for managing and performing functions related to grievances, monitoring, and overall compliance with the application of medical necessity criteria related to the denial process, compliance with the Commonwealth of Pennsylvania Department of Health regulations, Act 68, NCQA standards and HealthChoices reporting standards and other Community Care needs. The supervisor, grievances supports care management, professional advisor, and other staff and helps to facilitate case reviews related to denials and grievances. This position will also coordinate the training of the professional advisors and care managers related to the denial documentation process and review and development of medical necessity criteria.

A minimum of five years of clinical experience with two of those years in a management capacity is required. Qualified candidates must be licensed healthcare professionals with a bachelor's in nursing from an accredited program. Experience in managed care, the ability to implement quality assurance policies, enforce those policies through appropriate action, and maintain an effective professional liaison with all levels of executive and medical staff, including professional and institutional providers of care.

UPMC offers a competitive compensation and benefits package along with a strong growth-oriented working environment. We offer challenging projects and training to help ensure your success.

Visit http://jobs.upmc.com/Job.htm to apply online. Search openings and enter 1003976 in the Job Opening ID field.

UPMC is an equal opportunity employer.