Grievance Coordinator

TRILLIUM HEALTH RESOURCES•Remote in North Carolina, NC, US, NC

1d•$56,270 - $69,898•Remote

About The Position

Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties across North Carolina. We manage services for individuals with serious mental health needs, substance use disorders, traumatic brain injuries, and intellectual/development (IDD) disabilities. Our mission is to help individuals and families build strong foundations for healthy, fulfilling lives. Trillium believes that empowering others begins with supporting our team. We offer our employees: A collaborative, mission-driven work environment, Competitive benefits and work-from-home options for most positions, Opportunities for professional growth in a diverse inclusive culture. Every day, our work changes lives – from children thriving through early intervention and school-based therapies, to adults with severe mental illness living independently and contributing to their communities. If you are looking for a unique opportunity to make a tangible impact on the lives of others, apply today! Trillium Health Resources has a career opening for a Grievance Coordinator to join our team! The Grievance Coordinator is responsible for maintaining and coordinating grievance and complaints. Coordinators are responsible for providing support to members and recipients, providers and other callers seeking to file a concern; monitoring and maintaining accurate grievance policies and procedures based on State and Federal guidelines, NCQA standards and other measures; and maintaining and reporting grievance; and complaint statistics. Additional duties are needed to support the grievance and complaint process.

Requirements

High School Diploma/GED and six (6) years’ experience working with the adult mental health, developmental disabilities or substance use population or field; OR Associate’s degree and minimum four (4) years’ experience working with the adult mental health, developmental disabilities or substance use population or field; OR Bachelor’s degree and minimum two (2) years’ experience working with the adult mental health, developmental disabilities or substance use population or field; OR Equivalent combination of education/experience.
Must have a valid driver’s license.
Must reside within North Carolina.
Must be able to travel within catchment as required.

Nice To Haves

Experience providing crisis intervention or crisis response to individuals within the mental health, developmental disabilities or substance abuse population.

Responsibilities

Evaluate/investigate the circumstances of the grievance/complaint, which includes interacting with callers to gather information regarding their concern, collaboration with other internal Trillium departments to help gather information and documents for the investigation, and document in the grievance/complaint module.
Interfaces with providers and external entities, as required, to resolve grievances and complaints.
Uses professional discretion to determine whether allegations contained in grievances or complaints violate established rules or policies and helps determine what is an appropriate response to the contents of complaints or grievances.
Maintain and adjudicate member and recipient grievances and complaints in a timely manner, ensuring notification letters are updated and sent to the grievant/complainant accurately and timely based on the most current formats and timelines as established by State and Federal regulations.
Maintain and update the grievance module, spreadsheets and Trillium’s on-line grievance/complaint submission portal to help track, and report on grievance/complaint data for NCQA, EQR and State Requirements as well as gather information for the Compliance Committee.
Establish and ensure grievances and complaint files are maintained in accordance with 42CFR and contractual and accreditation standards.