Grievance and Appeals and State Fair Hearing Program Business Change Manager, Senior

Anticipated End Date:

Position Title:

Job Description:

Grievance and Appeals and State Fair Hearing Program Business Change Manager, Senior

Location: Overland Park or Topeka, Kansas. This role is required to be domiciled in the state of Kansas.

Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. 

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. 

The Grievance and Appeals Program Business Change Manager, Senior​ will be responsible for managing Provider Grievances, Provider Appeals, and Provider State Fair Hearings for the Kansas Health Plan.

Responsible for working with management to identify and implement varied projects, programs and plans that support achievement of business unit and enterprise goals.

How you will make an impact:

• Identifies potential issues, project change, and scope.
• Leads efforts to identify best practices. Identifies impacted parties, business partners, and resources required.
• Develops and designs processes and systems that support business needs.
• Designs methods for integrating function and process.
• Conducts cost/benefit analyses.
• Builds support for business change throughout the business unit.
• Ensures State Fair Hearing notices and case documentation are accurate and complete.
• Supports all State Fair Hearing materials timely submission.
• Ensures all Member and Provider cases are appropriately tracked and reported, and records remain audit-ready.

Minimum Requirements:

• Requires a BA/BS in a related field and minimum of 8 years process improvement, business change or project related experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Experience with Provider Grievances, Appeals, administrative hearings, or other legal processes strongly preferred.
• Experience with accurate, complete, and timely regulatory documentation and submission is strongly preferred.
• Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
• Experience as a legal assistant or paralegal or comparable education or employment experience is strongly preferred.
• Experience in successfully developing and managing projects with fairly significant operating budget and knowledge of process redesign strongly preferred.

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Workshift:

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Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.