Senior Director and Grievance Officer, Appeals and Grievances

The Senior Director and Grievance Officer, Appeals and Grievances is responsible for leadership, operational execution, clinical and regulatory oversight, and enterprise governance of L.A. Care's grievance, appeal, and State Fair Hearing functions across all product lines.

Requirements

• At least 9 years of experience in health plan operations, managed care, A&G, utilization management, clinical operations, or regulatory compliance.
• At least 8 years of leading staff, supervisor/management experience.
• Experience leading teams, projects, initiatives, or cross-functional groups.
• Extensive leadership experience in Medicaid, Medicare, and Commercial managed care lines of business.
• Experience navigating regulatory and accreditation requirements.
• Experience improving operational accuracy, strengthening documentation quality, and ensuring consistent alignment with federal and state regulatory expectations.

Benefits

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program
• Volunteer Time Off (VTO)