Job Description

Point of contact for Health Plan member grievances and internally identified potential quality of care issues (PQI – Potential Quality Issues). Responsible for coordinating the process with receipt and initial processing (including data entry, record requests and follow ups) for member grievances and other quality of care concerns from internal and external sources.

Maintains documentation in databases as required, coordinates and communicates with provider offices and other involved entities, ensuring documentation is requested and received, while managing TATs within Health Plan timelines (24 hours to 10 days, depending on type of request). This person will be handling grievances and appeals for the front-line staff health plans (internal PQI – Potential Quality Issue) and will be gathering patient records and responses.

- Fully Remote
- Hours: 8-5 pm PST
- 3MC w/ possibility of extension
** Needs to be comfortable ...