Medicaid Appeals & Grievance Associate Manager

Job not on LinkedIn

🕒 September 21

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

💵 $47k - $91.8k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Coordinate effective resolution of member and/or provider/practitioner appeals, complaints and grievances • Manage staff and oversee day-to-day resolution of appeals, complaints and grievances across products • Implement Aetna's appeals, complaints and grievances policies and procedures • Identify trends and issues, report findings, and recommend solutions • Manage team productivity, resources, workload, performance measures, quality, and cost effectiveness • Serve as a content model expert and mentor on policies, procedures, regulatory, and accreditation requirements • Participate in staff selection • Build functional teams through training, assignments, coaching, mentoring, and development • Assess developmental needs and implement action plans for high-performing teams and individuals • Ensure work meets federal and state requirements, quality measures, letter-content standards, and turnaround times • Lead change efforts and manage team transitions • Carry a modified caseload, including researching appeals, complaints, grievances, benefit language, claim processing logic, eligibility, billing/payment status, and coverage documentation

🎯 Requirements

• Must live in Louisiana • Experience in reading or researching benefit language • Excellent verbal and written communication skills • Solid project management skills • Excellent customer service skills • Experience documenting workflows and reengineering efforts • Bachelor's degree or equivalent experience • Ability to meet federal and state requirements and quality measures for appeals, complaints and grievance handling

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being