Appeals Program Manager

The Appeals Program Manager will develop and maintain quality assurance tools and audit mechanisms, including uploading monthly CPE audits, identifying deficiencies, and ensuring action plans are in place. They will also maintain and update standard operating procedures (SOPs) to reflect the latest regulatory and internal guidance. This role involves leading and supporting internal and external audits to achieve zero CARs or ICARs, partnering with the Compliance team, leading Part C reporting and timeliness metrics, and preparing necessary documentation. The manager will represent the Appeals department in cross-functional efforts, monitor monthly trends from end-to-end audits, and maintain accurate data for reporting. Additionally, they will provide quality refreshers to existing team members, support new hire onboarding with structured quality training, and coach and mentor staff on quality expectations and audit protocols.