Grievance Coordinator Temporary

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ABOUT THIS TEMP POSITION
This is a temporary position and the length of assignment is estimated to go from 10/2022 to 12/31/2022. The length of the assignment is always dependent on business need and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with.
WHAT YOU'LL BE RESPONSIBLE FOR
Reporting to the Grievance Supervisor, you will assist in the administration and/or resolution of low complexity cases in support of the Alliance Grievance function. You will perform administrative duties to track, organize, monitor and follow up on case work. You will participate in departmental and cross departmental trainings, workgroups, and operational improvement activities
ABOUT THE TEAM
Grievance work involves complex coordination, investigation and specific resolution within regulatory timeframes. The Grievance team is organized by Member Complaint and Provider Dispute specialties. Areas of Grievance work include:
Member Complaints:
An oral or written statement submitted by a member or a member's authorized representative expressing dissatisfaction with any aspect of the Alliance's health care plan.
Expedited Complaints:
A complaint involving an imminent and serious threat to the health of the member, as determined by an Alliance Medical Director that includes, but is not limited to, severe pain, potential loss of life, limb or major bodily function.
Appeals:
A member complaint involving an Alliance Utilization Management (UM) decision.
State Fair Hearings:
The process whereby a member enrolled in Medi-Cal requests the Department of Social Services (DSS) and its Administrative Law Division to resolve Plan decisions that deny, modify or delay health care services or affect Medi-Cal benefits.
Inquiries:
A question or request for information or assistance by a member that does not reflect the member's dissatisfaction with any aspect of the Alliance's health care plan.
Complex Member/Provider Billing Issues:
When an Alliance member receives a bill from a medical provider for covered services.
Provider Disputes:
A provider's written statement of dissatisfaction regarding the Alliance's action or inaction
WHAT YOU'LL NEED TO BE SUCCESSFUL
To read the full position description, and list of requirements click here
Knowledge of:
The principles and practices of managed healthcare, healthcare coverage and benefit structures, principles of coordination of benefits and medical billing
Title 22 and Title 28 utilization management and grievance regulations
The diverse needs of the Medi-Cal population
Proper grammar, spelling, punctuation and formatting
Ability to:
Understand and communicate the complex operations and processes of the Alliance, particularly the Utilization Management, Care Management and Member Services departments
Use the Alliance's internal tracking systems
Draft professional correspondence
Education and Experience:
Associate's Degree in health, social services or a related field or Medical Assistant certification
One year of experience in a managed health care setting, health plan, or provider office interacting with members, patients, and/or providers and experience with receiving complaints, preferably related to healthcare administration or public assistance; or an equivalent combination of education and experience may be qualifying
OTHER DETAILS
While this position is connected to one of our Alliance offices, we are in hybrid telecommute work environment right now and we anticipate that the interview process will take place remotely.
Our Alliance office locations have officially re-opened as of May 2, 2022 and while some employees may work in full-time telecommute schedules, attendance at quarterly company-wide events or department meetings will be expected.
Based on the nature of work, this position may require onsite presence, which is dependent on business need. Details about this can be reviewed during the interview process
This is a temporary position, and does not provide the benefits that are listed below (it is standard language from our regular job posts and cannot be altered or removed)
COVID-19 Vaccine Requirement:
This position requires staff to be fully vaccinated and boosted upon their start date as a condition of employment. Proof of vaccination must be submitted at time of hire. Fully vaccinated and boosted is defined as receipt of the second dose in a 2-dose series (Pfizer & Moderna vaccines) OR receipt of a single-dose vaccine (Johnson & Johnson); AND receipt of the booster (if eligible); AND a 2-week period having passed since the administration of the last vaccine dose.
Additionally, all positions at the Alliance are required to meet these minimum qualifications.
OUR BENEFITS
Medical, Dental and Vision Plans
Ample Paid Time Off
11 Paid Holidays per year
401(a) Retirement Plan
457 Deferred Compensation Plan
Robust Health and Wellness Program
EV Charging Stations
And many more
ABOUT US
We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at **MEMBERS ONLY**SIGN UP NOW***. (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Merced, Monterey and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet
At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

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