Appeal Resolution Manager manages the grievance process to review, investigate, document, process, negotiate, and resolve disputed medical, insurance, and other claims. Oversees work activity that is compliant with all regulatory guidelines and policy protocols. Being an Appeal Resolution Manager allocates team resources to ensure an effective and balanced case workload. Applies industry standards and uses best practices in the preparation of legal briefs. Additionally, Appeal Resolution Manager may represent the organization at hearings. Requires a bachelor's degree. Typically reports to a senior manager or head of a unit/department. The Appeal Resolution Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. To be an Appeal Resolution Manager typically requires 5 years experience in the related area as an individual contributor. 1 - 3 years supervisory experience may be required. Extensive knowledge of the function and department processes. (Copyright 2024 Salary.com)
ESSENTIAL JOB FUNCTIONS
Navigation includes providing services to customers of all ages, including offering resources and strategic referrals for individuals and families in need of services and support; provides impartial and unbiased consultation, advocacy, and extensive independent review of customer’s needs in support of successful exiting from homelessness; provides access to services offered by municipal, county, non-profit, and faith-based systems otherwise unattainable by customer’s efforts alone.
Provides direct service to customers by assisting with transportation and coordination of in-person meetings between customers, landlords and involved professionals for potential housing placements; facilitates communication via phone calls, emails, and other methods of communication, provides referral and resources support, entry and exit follow up plan development, and participation in individualized service and support teams. Follows up with individuals and families and provides resources. Applies knowledge of multiple individual and family serving agencies in the region to all these activities.
Gathers and maintains information on resources and eligibility requirements for services available to individuals and families. Gathers qualitative and quantitative data from individuals and families regarding services. Prepares and reviews documents (case notes, meeting information); collects and distributes information; responds to navigation inquiries from individuals, families and professionals.
Facilitates goal development, provides ideas and input for housing and stabilization outcome goals, and participates on subcommittees to carry out those goals, follows up with individuals and families, and provides resources; offers expertise around best and promising practices; works within the regional navigation team and other regional boards, committees, and groups to accomplish objectives.
Provides navigation support as a wraparound facilitator and/or liaison with any other system or professional the customer is involved with.
Coordinates and expedites services for customers in need through the following activities: researches and presents data collection tools; designs individual and family involvement opportunities through participation on subcommittees; gathers qualitative and quantitative data from individuals and families regarding services; manages and analyzes data in spreadsheets and databases.
Assists in planning, development, implementation and management of program strategies, policies, procedures, goals and performance measures; tracks and reports on the progress of goals and performance measures; makes recommendations for changes or improvements to achieve desired outcomes.
Works with HMIS or similar system to house program information to include: data and statistics, strategic and operational issues; action plans and strategies, resources, and other information relevant to the program.
Researches national evidence based practices in the areas of housing strategies and interprets the complex data and information in simplified and easily understood formats using tables, graphs, or other visual aids.
Attends trainings with government and community agencies that service individuals and families.
Collaborates and coordinates closely with Public Safety, Housing, Parks, Courts, City Manager’s Office, City Attorney’s Office and other city staff and work systems to accomplish city goals and objectives.
In conjunction with the Court Administrator, is responsible for managing the city program that serves defendants experiencing homelessness, known as the “One Small Step” program; works to ensure the program utilizes the services of appropriate community resource providers, and coordinates the services those providers deliver to the program; works closely with the City Attorney’s Office and those tasked with assessing or evaluating the compliance of defendants in the program to ensure the effective operation of the program.
Collaborates with a variety of municipal, county, non-profit, faith-based systems, and other applicable agencies to coordinate systems and deliver on program goals.
Frequently operates a personal or City-owned motor vehicle to drive to and from work locations throughout the City.
Demonstrates a respectful attitude towards customers, coworkers and partners that promotes teamwork, open communication, and effective customer service.
Acts with the customer in mind, responds to requests promptly and provides effective services or solutions for customers.
Exercises appropriate level of initiative and judgment to make decisions within the scope of assigned authority.
ESSENTIAL KNOWLEDGE, SKILLS AND ABILITIES
Broad knowledge of poverty and homelessness causes, trends, issues, and solutions.
Knowledge of existing community resources available to assist individuals experiencing homelessness.
Training in trauma informed care.
Experience coordinating and collaborating with internal staff and external partners to accomplish objectives.
Knowledge or experience with developing and managing policies, procedures, goals, timelines and performance measures.
Ability to analyze and evaluate program data and make course corrections or recommendations as needed for successful outcomes.
Strong customer service and customer/client relationship skills.
Solid computer skills with ability to maintain databases and enter/organize data accurately.
Strong organizational skills and experience maintaining filing systems.
Ability to engage customers in the field with direct service provision.
Ability to interact and collaborate with others, share information, and provide consultation and advice.
Ability to consider different points of view and to use elements of persuasion to gain cooperation and acceptance of ideas, and to reach agreement.
Ability to apply comprehensive, practical and technical knowledge with use of analytical judgment and decision making abilities.
Ability to effectively communicate information, both verbally and in writing, to support organizational objectives and interact with all levels of personnel within the city and the public in a positive and cooperative manner.
Ability to read and comprehend a variety of written communications and publications.
Ability to research, interpret, analyze and evaluate data.
Ability to handle conflict and maintain composure under pressure.
Frequently operates a personal or City-owned motor vehicle to drive to and from work locations throughout the City.
Available to work a regular Mon-Fri schedule with flexibility on evenings and weekends and willingness to be on-call to respond to emergent situations
OTHER FUNCTIONS:
1. Other duties as assigned.
—Employees are held accountable for all duties of this job—
SCOPE OF AUTHORITY:
Receives general supervision under the direction of the Homelessness Program Manager. Plans and prioritizes daily work activities and tasks. Supports the preparation and/or development of plans for projects and programs involving coordination with other departments and/or outside organizations. Few established precedents and/or procedures exist. Employees are expected to follow procedures and handle difficult and specialized situations in functional area with support from the supervisor.
Financial Accountability:
None
SUPERVISION EXERCISED:
None. May lead or instruct other employees, project teams or collaborators to accomplish objectives.
WORKING ENVIRONMENT/PHYSICAL ACTIVITIES:
The work environment/physical activities described here are representative of those an employee encounters while performing the essential functions of the job.
Work is primarily performed in an office environment with moderate noise levels. With a representative from the Police, this position will visit camps, parked cars, and other sites to meet people where they are as well as in-person visits in an office environment. Physical effort and activities include: occasionally operating a personal or City-owned motor vehicle to drive to and from meetings and business locations; ability to talk, hear and listen, use of hands/fingers to type and handle, feel or manipulate objects constantly; frequent sitting; occasional standing, walking, and reaching with hands and arms; visual acuity to focus on details at a close distance, and make general observations and inspections; frequent handling of objects weighing up to 10 pounds, and up to 50 pounds occasionally.
MINIMUM REQUIRED QUALIFICATIONS (EDUCATION, LICENSE, TRAINING AND EXPERIENCE):
Bachelor’s degree in social work or a related field and one (1) years of related experience. Experience or training in trauma informed care and/or poverty or homelessness issues required. CJIS background check. A valid Colorado driver’s license and acceptable driving record is required.
The City is an Equal Employment Opportunity
The City’s Core values are in every employee’s individual Performance Plan which helps us to reinforce our expectations for living and working by our Core Values.
Every City employee is expected to perform his/her job to the highest professional standards. This includes upholding the City’s values with integrity and accountability, acting in a manner that is respectful and inclusive towards others, and adhering to the City’s policy on employee conduct as detailed in the personnel rules sec. 70-143.
Vision: We Dream Big and Deliver
Mission: We are dedicated to delivering superior services to enhance the lives of everyone in our community.
Values:
Innovation: We excel in creativity, flexibility and the use of best practices while valuing diverse backgrounds, ideas and perspectives.
Passion: We are a high performing, inclusive team inspiring each other to pursue excellence.
Opportunity: We value our diversity, embrace possibilities, face challenges, persevere and take action to deliver quality results.