Complaints & Grievances Specialist

Community Behavioral Health. • Philadelphia, PA

2d • $0 - $58,300 • Onsite

About The Position

CBH is a dynamic organization dedicated to providing access to high-quality, accountable care to improve the health and mental wellness of our members. As part of our growth, we are seeking a detail-oriented Complaints & Grievances Specialist to join our team. The Complaints & Grievances Specialist is responsible for completing thorough investigations of members’ complaints and processing grievances, conducting and participating in hearings in addition to ensuring all State mandates are being followed.

Requirements

• Master’s Degree in behavioral health, healthcare or social sciences
• Minimum of 2 years of experience in a managed care or quality management setting
• Proficient in Microsoft office applications
• Excellent written and verbal communication skills
• Knowledge of PA Act 146, Appendix H and medical necessity criteria
• Excellent customer service skills
• Excellent training & facilitating skills
• Strong interpersonal skills
• Thorough knowledge of DBH and DHS systems and services
• Regularly requires walking, standing, stooping, bending, sitting, reaching, pushing, pulling and/or repetitive wrist/hand movements for various lengths of time throughout the day.
• Ability to utilize computers and office equipment to complete daily work responsibilities.
• Regularly works inside in areas that are adequately lighted and ventilated. Some fluctuation in temperature. No protective equipment routinely needed.
• Must be able to adapt to continuous changes/demands of the job.
• Must be able to travel.
• The successful candidate must be a current Philadelphia resident or become a resident within six months of hire.
• All candidates must be legally authorized to work in the United States without requiring sponsorship now or in the future.

Nice To Haves

• N/A

Responsibilities

• Review, document and process all levels of complaints and grievances
• Complete packet for and participate in Fair Hearing
• Review and address Quality Concerns stemming from complaints and grievances to determine level of follow up required (i.e., investigating or tracking).
• Travel is required for this position.

Benefits

• Family Planning, Fertility, Adoption Benefits
• 403B Retirement Plan
• PTO Days/Sick Days
• Wellness Program
• Employee Assistance Program
• Health, Dental, Vision Insurance
• Medical, Prescription Drug Insurance
• Tuition Reimbursement
• Commuter Benefits
• Flexible Spending

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level