Manager, Grievances and Appeals – Operations

SCAN

. Manage daily operations within the SCAN Grievance and Appeal program.

Posted 10/13/2026full-timeLong Beach • California • United StatesMid-LevelSenior💰 $80,300 - $116,197 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing Grievance and Appeals operations within healthcare, ensuring compliance with CMS, DMHC, and DHCS regulations. Proven ability to lead teams, implement process improvements, and maintain high standards of productivity and quality.

Highest-signal resume keywords

Grievance And Appeals ManagementRegulatory ComplianceTeam LeadershipProcess ImprovementHealthcare Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Strategic PlanningCritical ThinkingAnalytical SkillsMicrosoft Office SuiteMedicare GuidelinesMedi-Cal GuidelinesDMHC GuidelinesDHCS GuidelinesNCQA GuidelinesStaff Training

Soft Skills

Interpersonal SkillsPresentation SkillsOrganizational SkillsProblem SolvingCommunication Skills

Industry Keywords

Managed CareHealthcare OperationsGrievance ProcessAppeals ProcessQuality Standards

About the role

Key responsibilities & impact

Manage daily operations within the SCAN Grievance and Appeal program.
Manage and oversee the Grievance and Appeals team, including day-to-day operations and productivity.
Establish and maintain workflows, systems, tools, and monitoring processes to complete grievance and appeal activities within required timeframes.
Perform process improvements and address areas of identified non-compliance.
Serve as the first-line resource for staff and assist with problem solving.
Implement and maintain proper staffing, including temporary staff.
Establish processes for understanding, training to, and monitoring adherence to CMS, DMHC, DHCS, and other regulatory and quality standards.
Ensure staff review incoming Medicare Part C and Part D inquiries, determine case classification, and prepare cases for Pharmacist or Medical Director review.
Facilitate staff and interdisciplinary team meetings.
Maintain current department policies, procedures, workflows, job aids, and training materials.
Partner with stakeholders and department management on productivity and efficacy metric reporting.
Serve as department subject matter expert and represent the department at assigned committees.
Interface with the HCS Medical Director to ensure quality case review.
Recruit, select, orient, and train employees; maintain a safe work environment; and develop growth opportunities.
Support SCAN's Vision and Goals.
Perform other duties as assigned.

Requirements

What you’ll need

Bachelor's Degree or equivalent experience in Healthcare or human service-related field of study.
5+ years in managed health care setting, Medicare/Medicaid preferred.
Excellent presentation skills, group motivation and supervisory skills.
Strong strategic planning, critical thinking and leadership skills.
Demonstrated management experience.
Experience with coordinating diverse groups of individuals to achieve success of the overall program.
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.
Demonstrated ability to work with all levels of staff, within and external to the organization to achieve goals.
Microsoft Office Suite experience at advanced level.
A background check is required.

Benefits

Comp & perks

An annual employee bonus program
Robust Wellness Program
Generous paid-time-off (PTO)
Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
Excellent 401(k) Retirement Saving Plan with employer match and contribution
Robust employee recognition program
Tuition reimbursement
Equal pay, employee resource groups, inclusive benefits, and more