Grievance and Appeals Coordinator

South Country Health Alliance • Medford, MN

1d • $37 - $45 • Hybrid

About The Position

Grievance and Appeals Coordinator

Full Time Grievance and Appeals Coordinator South Country Health Alliance South Country Health Alliance is seeking a Grievance and Appeals Coordinator to join our team! This role is responsible for the management of his/her assigned caseload involving member complaints received at South Country Health Alliance (South Country), which may include member grievances or appeals. This person will perform advanced and complicated case review duties requiring clinical judgment, independent analysis, and detailed knowledge of departmental and regulatory procedures. What Youll Bring: An active Minnesota RN License and broad based clinical background; 3-5 + years Health plan experience and/or experience conducting complaint investigations; Proficiency in Microsoft Office, especially Word and Excel; Knowledge of federal and state regulatory requirements for appeals and grievances; A B.A. or B.S in Nursing is preferred Why South Country? South Country Health Alliance is more than a health planwere a mission-driven organization dedicated to improving health and well-being in rural Minnesota communities. Our work is guided by values of communication, collaboration, stewardship, and excellence, ensuring that every employee contributes to making a real difference in peoples lives. [mnscha.org] Join us and be part of an organization that values community impact, employee well-being, and innovation. South Country offers a wide variety of benefits including medical, dental, vision, health savings account contributions, PERA Pension, paid holidays, paid vacation, paid sick time, and more. This position is a hybrid position- requiring in office time in Medford, MN as organizationally necessary. Remote status will be dependent on experience, education, skill level, and needs of the organization. Salary for this position starts at $37.14- $45.43/hour, based on qualifications and experience. Must be legally authorized to work in the U.S. (No sponsorship available) Grievance and Appeals Coordinator Department: Grievance and Appeals Reports To: Grievance and Appeals Manager Pay Grade: 9 Supervises: None Revision Date: January 2026 JOB SUMMARY: The Grievance and Appeals Coordinator is responsible for the management of his/her assigned caseload involving member complaints received at South Country Health Alliance (SCHA), which may include member grievances or appeals. This person will perform advanced and complicated case review duties requiring clinical judgment, independent analysis, and detailed knowledge of departmental and regulatory procedures.

Requirements

• RN with an active license in the State of MN and a broad-based clinical background
• 3-5 years health care experience
• Knowledge of federal and state regulatory requirements for appeals and grievances
• Proficient in Microsoft Office, especially Word and Excel
• Ability to work independently
• Critical thinking skills
• Investigative and creative problem-solving skills
• Excellent written and verbal communication skills
• Ability to work cross departmentally and effectively with business partners including Third Party Administrators (TPAs), health care providers and professionals
• Organizational and time management skills
• Must be legally authorized to work in the U.S. (No sponsorship available)

Nice To Haves

• B.A or B.S in Nursing
• Health plan experience and/or experience conducting investigations or processing appeals

Responsibilities

• Processes member complaints and related requests thoroughly and completely by acquiring appropriate records and/or other information and applying problem-solving skills and investigative methodology, as well as clinical knowledge. Cases will be processed in accordance with regulatory requirements and departmental policies and procedures, ensuring timely and appropriate determinations.
• Coordinates the assigned case in its entirety, which may require obtaining the assistance of other South Country staff for review/investigation of information; will collaborate effectively with others, including, but not limited to South Countrys Medical Director, Health Services, Member Services and Operations departments, county staff, delegated entities and providers. Works closely with South Countrys Medical Director and other contracted clinicians, especially during review of quality-of-care complaints and appeals, to ensure necessary and timely completion of case related medical reviews.
• Maintains accurate and complete case documentation, which may include both electronic and hard copy case files. Ensures related correspondence is scanned into the electronic record.
• At times, may need to correspond with external regulatory agencies such as the Minnesota Department of Human Services (DHS), Centers for Medicare and Medicaid Services (CMS) and the Minnesota Department of Health (MDH). This would include work-related functions pertaining to State Appeals (also known as State Fair Hearings) and handling/processing of cases involving external independent review entities.
• Conducts necessary and appropriate case preparation, interviews, and record review. Upon initial receipt of complaint/request, reviews documentation and/or phone call(s) to ensure accurate identification and classification of concern(s) to properly route/process these cases. Job duties will also include appropriate triaging of cases to determine the need to expedite the cases and/or process in a timely manner according to the members health condition.
• Completes assigned duties related to internal and external data reporting; this may include tracking and analysis of complaints data on a daily, monthly or quarterly basis, and may involve preparation and timely submission of reports for South Countrys Quality Assurance Committee, Compliance Committee and mandatory annual CMS/quarterly DHS grievance and appeals data reports.
• As assigned, will conduct a review of member phone calls involving complaints and/or related requests for quality purposes; in follow-up to this, may need to provide feedback and/or additional guidance as needed to South Country staff who handled the member phone call and related request.
• As designated by South Countrys G/A Manager, completes daily monitoring and processing of any complaints received via CMSs Health Plan Management System (HPMS), Complaints Tracking Module (CTM). In addition to this, tracks and monitors quarterly complaint data received from external providers/clinics.
• Other job duties as assigned within the scope, responsibility and requirements of the job.

Benefits

• South Country offers a wide variety of benefits including medical, dental, vision, health savings account contributions, PERA Pension, paid holidays, paid vacation, paid sick time, and more.

What This Job Offers

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