Medical Compliance Review Liaison

TEKsystems•Fairfield, CA

1d•$40 - $43•Onsite

About The Position

The successful candidate will be responsible for overseeing grievance and appeal reviews, as well as conducting cultural and linguistic reviews for our subcontractors to ensure alignment with our commitment to diversity and inclusion. This role will provide support to department on promoting health equity within our organization and in the community, ensuring fair and just access to healthcare services for all members.

Requirements

Strong, effective oral and written communication skills.
Ability to work with ethnically and culturally diverse populations.
Requires patience and ability to work with people of all levels of understanding and education

Responsibilities

Conduct thorough reviews of grievances and appeals submitted by members to ensure compliance with regulatory requirements and company policies
Ensure timely trainings for practitioners pertaining to grievances that are determined to be discriminatory
Evaluate the cultural and linguistic competency of subcontractors and provide recommendations for improvement to enhance service delivery to diverse populations.
Monitors accreditation, contractual, legal, and regulatory requirements for cultural and linguistic services
Collaborate with internal teams to address and resolve member complaints in a timely and efficient manner.
Develop and implement training programs to educate staff and subcontractors on cultural sensitivity and effective communication strategies.
Maintains department files for auditing purposes (hard and soft copies) per instruction.
Provides support to champion health equity initiatives within the managed care system to address disparities in healthcare access and outcomes.
Other duties as assigned