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Associate Director NY Open (J#45408)

Title: Associate Director
Company: Visiting Nurse Service of New York

Job Description

Associate Director, Grievance & Appeal

VNSNY CHOICE Health Plans is seeking a dynamic, detail oriented leader to direct the operations of the grievance and appeals department for its Medicare and Medicaid products.

Duties and responsibilities will include:
- Ensuring processes are efficient and comply with regulatory requirements.
- Creating a proactive strategy in support of the organization's efforts to provide outstanding customer service, reduce costs, and improve operating efficiency.
- Reviewing policies and procedures, analyzing data for patterns and trends, and identifying opportunities for performance improvement.
- Collaborating with internal and external entities including, VNSNY CHOICE s Compliance and Regulatory Affairs, Sales and Marketing, Medical Management, Provider Relations and Claims departments, Center for Medicare and Medicaid Services and New York State Department of Health.

The ideal candidate must possess a working knowledge of various federal, state, and regulatory guidelines for processing member and provider correspondence. Knowledge of systems and databases are essential. Leadership skills required include: strategic planning, problem solving and establishing continuous performance improvement strategies in a fast paced environment.
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