Supervisor, Grievances & Appeals (GAD)

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do.

Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults.

Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity.

At SCAN, we believe scale should strengthen—not dilute—our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.

The Job

The Supervisor, Grievances and Appeals (GAD) ensures regulatory compliance in the processing of all complaints, grievances and appeals in that all cases are processed in accordance with state and federal agency requirements as well as SCAN Health Plan’s internal policies and procedures.

You Will

• Supervise and coordinate the day-to-day operations of the Grievance & Appeals coordinator staff.

• Train staff in the key departmental functions, including but not limited to: departmental policies and procedures, CMS and DHCS regulations, yearly plan’s benefits, review of cases assigned for Medi-Care Part C and Part D; correct classification of cases and the preparation of cases for review by a Pharmacist or Medical Director according to SCAN and Grievance and Appeals department policies and procedures to achieve organizational goals and outcomes.

• Check for and monitor understanding of all regulatory requirements and practices to meet department metrics, activities and interventions impacting 5 STAR and compliance measures.

• Ensure staff performance by being a resource for the team, resolving day-to-day issues, and problem solving issues related to case processes and case closures.

• Ensure staff completion of required activities (e.g. CTMs, ALJs, grievances and appeal functions) within the required timeframes by monitoring caseloads for turnaround times.

• Ensure compliance with and adhere to all regulatory and quality standards including but not limited to: Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), and Department of Managed Health Care (DMHC) as it relates to the Grievance and Appeal Department activities by establishing and maintaining processes, checking for understanding, training, monitoring adherence to the standards, and by preforming necessary process improvements to address areas of identified non-compliance.

• Develop and implement department policies, desktop procedures, workflows, job aids and training material. Recognize problems impacting Grievance and Appeals Department and develop solutions and either implement or discusses with direct report(s) as required.

• Prepare reports and statistics pertaining to grievances and appeals on a monthly and /or as needed basis, for submission to management, and regulatory agencies as required.

• Maintain staff by recruiting, selecting, orienting, and training employees; maintaining a safe and secure work environment; developing personal growth opportunities.

• Accomplish staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching, counseling, and disciplining employees; initiating, coordinating, and enforcing systems, policies, and procedures.

• We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.

• Actively support the achievement of SCAN’s Vision and Goals.

• Other duties as assigned.

Your Qualifications

• Bachelor’s degree in healthcare, Business or related field of study or a comparable combination of education/experience and/or training will be considered equivalent to the education listed above.

• 2+ years combined experience in grievance and appeal, internal audit, healthcare industry audit, compliance and/or operations

• 2+ years supervisory experience in managed care setting highly preferred.

• Excellent presentation skills, group motivation and supervisory skills.

• Ability to research, analyze and problem solve.

• Demonstrates keen attention to detail and produces high quality work products.

• Ability to prioritize multiple and competing tasks, work independently and in a team environment.

• Ability to work well in a fast-paced and dynamic environment.

• Strong interpersonal skills, including excellent written and verbal communication skills.

• Strong organizational skills; Ability to multitask.

• Ability to appropriately maintain confidentiality.

• Strong analytical and critical thinking skills, required.

• Working knowledge of guidelines and regulations relevant to Grievance and Appeals including Medicare, Medi-Cal, DMHC, DHCS and NCQA guidelines.

What's in it for you?

• Base Pay Range: $64,000 - $92,602 per year

• Work Mode: Mostly Remote

• An annual employee bonus program

• Robust Wellness Program

• Generous paid-time-off (PTO)

• 11 paid holidays per year, plus 1 additional floating holiday

• Excellent 401(k) Retirement Saving Plan with employer match

• Robust employee recognition program

• Tuition reimbursement

• An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team!  Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)