Manager, Grievances and Appeals (GAD) Operations

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 Manager, Grievances and Appeals Operations manages daily operations within the SCAN Grievance and Appeal program to assure that appeals and grievance rights provided to SCAN members are delivered efficiently, effectively and in accordance with all regulatory requirements.

You Will

• Ensure alignment to and achievement of the organizations goals by managing and overseeing the Grievance and Appeals team the day-to-day operations and productivity.
• Ensure completion of required activities for grievance and appeal functions within the required timeframes by establishing and maintaining effective workflow, systems, tools and monitoring processes and by performing necessary process improvements.
• Ensure staff performance by acting as the first line resource for staff and assisting in problem solving specific issues as well as improving systems and tools, implementing and maintaining proper staffing including use of temporary staff.
• 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 for understanding, training to, and monitoring adherence to the standards and by preforming necessary process improvements to address areas of identified non-compliance.
• Ensure staff is trained to review incoming inquires for both Medicare Part C and Part D, determine case classification, and prepare cases for review by either the Pharmacist or the Medical Director following SCAN and department policies and procedures to achieve organizational goals and outcomes.
• Ensure environment and culture of teamwork by facilitating staff meetings and interdisciplinary team meetings.
• Ensure that department policies and procedures, desktop procedures, workflows, job aides, and training materials, are current and accurately reflect processes in order to provide consistent quality care and comply with regulatory requirements.
• Partner with stakeholders and department management to create and review department metric reporting for productivity and efficacy to support organizational vision and goals.
• Function as the department subject matter expert and represent department at assigned committees to support two-way communication.
• Interface with HCS Medical Director to ensure quality case review occurs in accordance with department policy and procedures.
• Maintain staff by recruiting, selecting, orienting, and training employees; maintaining a safe and secure work environment; and developing personal growth opportunities.
• 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 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.

What's in it for you?

• Base salary range: $80,300 to $116,197 per year
• Internal title
• Work Mode
• 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
• 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.

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)

Life at SCAN

Become part of a mission-driven team that makes a difference in the lives of seniors every day.

SCAN has a long history of finding and investing in ways to meet seniors' needs. This focus is what attracts employees to SCAN. For each and every one of us, the SCAN mission is personal. Keeping Seniors Healthy and Independent is both our mission and our passion.

That same commitment carries over to our employees. We provide the training, tools and support necessary to do your work. We reward effort and celebrate success. SCAN both develops and attracts people who are leading experts in their respective fields.

If the SCAN mission is one you believe in too, we invite you to explore the career opportunities at SCAN.

Why consider a career at SCAN?

- A competitive compensation and benefits program;
- An annual employee bonus program;
- Generous paid-time-off (PTO);
- Eleven paid holidays per year;
- Excellent Retirement Savings program;
- A work-life balance; and
- An opportunity to become part of a team that makes a difference to our members and our community every day!