Supervisor, Quality Performance & Grievance and Appeals

Job Overview The Supervisor, Quality, Grievance & Appeals is responsible for the daily oversight, coordination, and performance of all Grievance & Appeals (G&A) functions, while also leading key Quality Management activities that drive regulatory compliance and organizational performance. This position supports the execution of enterprise quality initiatives, including HEDIS, CMS Star Ratings, DMHC quality performance measures, and internal quality improvement programs. It collaborates closely with Quality leadership, Utilization Management, Population Health, and operational teams to identify trends, implement corrective actions, and promote a positive member and provider experience. The role provides supervision to both clinical and non‑clinical staff and ensures timely, accurate, and compliant processing of grievances and appeals, potential quality issues (PQIs), and quality‑of‑care reviews. Minimum Requirements Bachelor’s degree in healthcare administration, public health, nursing, or a related field (or equivalent experience). Minimum of 3years of experience in healthcare grievances and appeals, quality, compliance, or managed care operations. Minimum of 2years of healthcare quality improvement or performance measurement experience (HEDIS/Stars preferred). Experience conducting PQI/QOC reviews or supporting clinical quality investigations. Minimum 1year of supervisory or lead experience. Current LVN license issued by the State of California, Vocational Nursing, and Psychiatric Technicians. Minimum requirement of a valid BLS certification or higher, following the American Heart Association (AHA) or the American Red Cross guidelines. Compensation $73,262.64 - $91,540.80 annually. Benefits & Career Development Medical, Dental and Vision insurance 403(b) Retirement savings plan with employer matching contributions Flexible Spending Accounts for Commuter and Career Advancement Paid Time Off & Holidays Paid CME Days Malpractice insurance and tail coverage Tuition Reimbursement Program Corporate Employee Discounts Employee Referral Bonus Program Pet Care Insurance Compliance Statement AltaMed Health Services Corp. will consider qualified applicants with criminal history pursuant to the California Fair Chance Act and City of Los Angeles Fair Chance Ordinance for Employers. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if AltaMed Health Service Corp. is concerned about a conviction directly related to the job, you will be given a chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report. AltaMed Health Services Corporation is committed to providing equal employment opportunities for all qualified individuals. We strictly prohibit discrimination in employment based on race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin, age, medical condition, physical or mental disability, military or protected veteran status, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical conditions, genetic information, or any other characteristic protected by local, state, or federal law, ordinance, or regulation. We aim to create a respectful, valued, and inclusive workplace through training, advancement opportunities, and access to resources and support, fostering a diverse workforce that enriches our organization and improves our ability to effectively serve our clients and community. #J-18808-Ljbffr AltaMed Health Services Corp