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 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 time frames 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…