Customer Service Grievance Specialist

DETROIT WAYNE Integrated HEALTH Network•Detroit, MI

17d•Hybrid

About The Position

Under the general supervision of the Director of Customer Service, the Customer Service Grievance Specialist is responsible for assuring that DWIHN’s grievance process is carried out in accordance with local, state, and federal regulations, BBA, Mental Health Code mandates and MDHHS contract. This role assists with the development of grievance processes and procedures, provides customer service information and referral, and oversees telephone and walk-in inquiries. The specialist monitors the grievance process for compliance, collaborates with internal/external entities, and maintains a reporting mechanism for complaints and grievances. They also analyze grievance data for trends, prepare reports, and provide technical assistance and training on grievance protocols. Additionally, the role involves developing and maintaining educational materials, attending meetings, and fostering collaboration to improve community integration and wellness outcomes. Performs related duties as assigned.

Requirements

Knowledge of DWIHN policies, procedures, and practices.
Knowledge of the DWIHN provider network and community resources.
Knowledge of the Michigan Mental Health Code.
Knowledge of MDHHS policies, rules, regulations, and procedures.
Knowledge of the appeals and grievance processes for behavioral health systems.
Knowledge of dispute resolution practices and procedures.
Knowledge of customer service.
Knowledge of compliance standards.
Knowledge of the Federal Confidentiality Regulations, 42 CFR, Part 2.
Knowledge of documents / regulations that govern the provision of mental health services, e.g., Medicaid Manual Mental Health and Substance Abuse Chapter III, State Plan for Medicaid, Michigan Department of Health and Human Services Quality Plan, BBA requirements and the Mental Health Code.
Knowledge of the principles, practices, and techniques of fact finding and conducting investigations.
Assessment skills.
Organizational skills.
Analytical skills.
Time Management skills.
Report writing skills.
Decision Making skills.
Customer Service skills.
Communication skills.
Active Listening skills.
Skill at meeting deadlines.
Multitasking skills.
Prioritizing skills.
Written communication skills.
Accuracy and detailed oriented skills.
Investigation skills.
Training skills.
Computer skills (Word, Excel, Access, Power Point, Outlook, Teams).
Ability to communicate orally.
Ability to communicate in writing.
Ability to work effectively with others.
Ability to act ethically and with confidentiality.
Ability to work with an ethnically, linguistically, culturally, economically and socially diverse population.
Judgement/Reasoning ability.
A Bachelor’s Degree in Social Work, Psychology, Healthcare Administration, Health Management, Business Administration, Conflict Resolution or a related field.
Four (4) years of full-time paid experience in complex cross-functional dispute resolutions or enrollee/member relations.
OR Four (4) years of full-time paid experience in a member facing Customer Service position.
A valid State of Michigan Driver’s License with a safe and acceptable driving record.

Responsibilities

Assists with the development of grievance process and procedures in accordance with Federal Rules, MDHHS guidelines, Michigan Mental Health Code and DWIHN policies and procedures.
Provides applicable Customer Service information, referral, and linkage.
Provides oversight of telephone and walk-in-inquiries.
Assists with the monitoring of the grievance process at DWIHN and contractor network to ensure compliance with established policies and procedures.
Collaborates and coordinates with various internal/external entities to ensure that issues are addressed in accordance with mandated policies and procedures.
Maintains the reporting mechanism that tracks and monitors DWIHN and contractor’s network complaints and grievances.
Assists in the review and analysis of grievance data for reporting of trends and patterns.
Assists in the preparation of weekly, monthly, quarterly, and annual DWIHN, ICO and MDHHS reports on grievance activity.
Provides technical assistance to DWIHN staff and contractors on grievance protocol and applicable dispute resolution protocols.
Develops and implements on-going grievance training modules specific to applicable audiences i.e., DWIHN staff, contracted providers, enrollees, and family members.
Assists in the development and maintenance of standardized grievance educational and informational materials (i.e. handbook, posters, forms, policies etc.).
Attends periodic meetings within DWIHN and/or the community to address DWIHN’s issues and updates that are applicable to grievance activities.
Fosters a climate of collaboration and innovation to improve upon community integration and wellness outcomes among individuals who receive services.
Performs related duties as assigned.