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Grievance Lead
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$19.75 - $26 an hour
Full-time
- AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population.
- Ensures that case documents are audit-ready and grievances and appeals are handled per QUEST Integration, CMS, NCQA, and other accreditation and regulatory requirements and AlohaCare standards.
- Lead continued development and implementation of an organizational grievance training program regular training of departments and individual staff as required to assist in ensuring regulatory compliance.
- Identifies trends and with Grievance and Appeals Manager in improving operational processes that impact on member satisfaction and complaint numbers.
- Provides guidance to Junior Grievance Coordinators and Grievance Coordinators in the review, research, monitoring and routing of complaints, grievances and appeal cases to appropriate personnel to assure timely, corrective and documented resolution is achieved.
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