Senior Director, Appeals & Grievances (Hybrid)
Morgan Consulting Resources, Inc. - Healthcare Executive Search, Los Angeles, CA, United States
Morgan Consulting Resources, Inc. has been retained by
L.A. Care Health Plan
to conduct the search for a
Senior Director and Grievance Officer, Appeals and Grievances . This position is based in Los Angeles, CA, with a hybrid schedule. About L.A. Care Health Plan Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. L.A. Care continues to operate in an increasingly complex and highly regulated environment, where Appeals & Grievances functions are under heightened scrutiny and play a critical role in ensuring regulatory compliance, operational integrity, and member experience. About the Senior Director and Grievance Officer, Appeals and Grievances Reporting to the Chief Operating Officer (COO), the Senior Director and Grievance Officer will lead the ongoing evolution of the organization’s Appeals & Grievances function into a highly reliable, audit-ready, and enterprise-integrated capability, ensuring consistent, accurate, and compliant case handling across all lines of business. This role carries enterprise-level accountability for grievance and appeal operations, including regulatory compliance, clinical decision oversight, audit readiness, and governance. The Senior Director will be responsible for strengthening internal controls, improving documentation quality, and ensuring the organization can consistently meet regulatory expectations in a high-volume, high-stakes environment. To view the comprehensive list of job responsibilities & required skills, click here. Education & Experience Requirements Bachelor’s degree required. In lieu of degree, equivalent education and/or experience may be considered. Master’s degree in business administration or related field preferred. Registered Nurse (RN) – Active, current and unrestricted California license preferred. 9+ years of experience in health plan operations, managed care, appeals & grievances, utilization management, clinical operations, or regulatory compliance. 8+ years of supervisor/management experience leading staff. Experience leading teams, projects, initiatives, or cross-functional groups. Extensive leadership experience in Medicaid, Medicare, and Commercial managed care lines of business, with deep understanding of their operational, regulatory, and service requirements. Experience navigating regulatory and accreditation requirements, with a strong track record of applying complex regulatory standards to grievance, appeal, and quality-of-care operations. Experience improving operational accuracy, strengthening documentation quality, and ensuring consistent alignment with federal and state regulatory expectations. Experience leading organizations through high-stakes regulatory audits, with a consistent record of achieving compliant outcomes and driving sustainable remediation. Extensive experience working within delegated, plan-partner, or subcontracted network environments, with demonstrated ability to oversee performance, ensure compliance, and manage complex accountability structures preferred. Experience leading vendor management activities, including performance oversight, Service Level Agreement (SLA) adherence, quality monitoring, and alignment with regulatory and contractual requirements preferred. Experience developing analytic dashboards and visualization tools (e.g., Power BI, Tableau) to support trend analysis, performance monitoring, and decision making preferred. L.A. Care’s mission is to provide access to quality healthcare for Los Angeles County’s vulnerable and low-income residents to support the safety net required to achieve that purpose. L.A. Care’s vision is a healthy community in which all have access to the health care they need. Organizational Values: Accountable and responsive to the communities we serve and focus on making a difference. Reflects a commitment to cultural diversity and the knowledge necessary to serve our members with respect and competence. Driven by continuous improvement and innovation and aims for excellence and integrity. Demonstrates L.A. Care’s leadership by active engagement in community, statewide and national collaborations and initiatives aimed at improving the lives of vulnerable low-income individuals and families. Fosters and honors strong relationships with our health care providers and the safety net. Empowers our members by providing health care choices and education and encouraging their input as partners in improving their health. Puts people first, recognizing the centrality of our members and the staff who serve them. Position Values: The Senior Director, Appeals and Grievances requires work after hours, on weekends, and holidays. Please anticipate on-call work with occasional flexibility in hours/shift in critical situations. This position will work remotely with 1-4 days on-site monthly in Los Angeles. Salary range: $171,925 (min.) - $232,100 (mid.) - $292,274 (max.) with annual bonus potential. The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. Benefits: Paid Time Off (PTO; tuition reimbursement; retirement plans; medical, dental & vision; wellness program; volunteer time off (VTO).
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L.A. Care Health Plan
to conduct the search for a
Senior Director and Grievance Officer, Appeals and Grievances . This position is based in Los Angeles, CA, with a hybrid schedule. About L.A. Care Health Plan Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. L.A. Care continues to operate in an increasingly complex and highly regulated environment, where Appeals & Grievances functions are under heightened scrutiny and play a critical role in ensuring regulatory compliance, operational integrity, and member experience. About the Senior Director and Grievance Officer, Appeals and Grievances Reporting to the Chief Operating Officer (COO), the Senior Director and Grievance Officer will lead the ongoing evolution of the organization’s Appeals & Grievances function into a highly reliable, audit-ready, and enterprise-integrated capability, ensuring consistent, accurate, and compliant case handling across all lines of business. This role carries enterprise-level accountability for grievance and appeal operations, including regulatory compliance, clinical decision oversight, audit readiness, and governance. The Senior Director will be responsible for strengthening internal controls, improving documentation quality, and ensuring the organization can consistently meet regulatory expectations in a high-volume, high-stakes environment. To view the comprehensive list of job responsibilities & required skills, click here. Education & Experience Requirements Bachelor’s degree required. In lieu of degree, equivalent education and/or experience may be considered. Master’s degree in business administration or related field preferred. Registered Nurse (RN) – Active, current and unrestricted California license preferred. 9+ years of experience in health plan operations, managed care, appeals & grievances, utilization management, clinical operations, or regulatory compliance. 8+ years of supervisor/management experience leading staff. Experience leading teams, projects, initiatives, or cross-functional groups. Extensive leadership experience in Medicaid, Medicare, and Commercial managed care lines of business, with deep understanding of their operational, regulatory, and service requirements. Experience navigating regulatory and accreditation requirements, with a strong track record of applying complex regulatory standards to grievance, appeal, and quality-of-care operations. Experience improving operational accuracy, strengthening documentation quality, and ensuring consistent alignment with federal and state regulatory expectations. Experience leading organizations through high-stakes regulatory audits, with a consistent record of achieving compliant outcomes and driving sustainable remediation. Extensive experience working within delegated, plan-partner, or subcontracted network environments, with demonstrated ability to oversee performance, ensure compliance, and manage complex accountability structures preferred. Experience leading vendor management activities, including performance oversight, Service Level Agreement (SLA) adherence, quality monitoring, and alignment with regulatory and contractual requirements preferred. Experience developing analytic dashboards and visualization tools (e.g., Power BI, Tableau) to support trend analysis, performance monitoring, and decision making preferred. L.A. Care’s mission is to provide access to quality healthcare for Los Angeles County’s vulnerable and low-income residents to support the safety net required to achieve that purpose. L.A. Care’s vision is a healthy community in which all have access to the health care they need. Organizational Values: Accountable and responsive to the communities we serve and focus on making a difference. Reflects a commitment to cultural diversity and the knowledge necessary to serve our members with respect and competence. Driven by continuous improvement and innovation and aims for excellence and integrity. Demonstrates L.A. Care’s leadership by active engagement in community, statewide and national collaborations and initiatives aimed at improving the lives of vulnerable low-income individuals and families. Fosters and honors strong relationships with our health care providers and the safety net. Empowers our members by providing health care choices and education and encouraging their input as partners in improving their health. Puts people first, recognizing the centrality of our members and the staff who serve them. Position Values: The Senior Director, Appeals and Grievances requires work after hours, on weekends, and holidays. Please anticipate on-call work with occasional flexibility in hours/shift in critical situations. This position will work remotely with 1-4 days on-site monthly in Los Angeles. Salary range: $171,925 (min.) - $232,100 (mid.) - $292,274 (max.) with annual bonus potential. The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. Benefits: Paid Time Off (PTO; tuition reimbursement; retirement plans; medical, dental & vision; wellness program; volunteer time off (VTO).
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