Complaints & Grievances Specialist

Community Behavioral Health; Philadelphia (Philadelphia County); On-site; USD 52,000 - 64,000; Full time

Job summary

Community Behavioral Health in Philadelphia, PA is seeking a dedicated Complaints & Grievances Specialist to investigate member complaints and process grievances, ensuring state mandates are followed. The role involves hearings and thorough documentation, with travel required as part of the duties.

The position requires a Master’s degree in behavioral health or related fields and at least 2 years of managed care or quality management experience.

Qualifications

• Master’s degree required in behavioral health, healthcare or social sciences.
• Minimum of 2 years of experience in a managed care or quality management setting.
• Must be able to travel for the role.

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
• Travel is required for this position

Skills

MS Office

Written communication

Interpersonal skills

ACT 146 knowledge

Education

Master’s degree in behavioral health, healthcare or social sciences

Tools

DBH/DHS systems

Job description

Complaints & Grievances Specialist

Philadelphia, PA, US

Salary: $58,300.00 Annually

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.

Position Overview: 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.

Essential Functions:

• 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.

Position Requirements:

• Education:Master’s Degree in behavioral health, healthcare or social sciences
• License/Certification (if applicable):N/A
• Relevant Work Experience: Minimum of 2 years of experience in a managed care or quality management setting

Skills:

• Proficient in Microsoft office applications
• Excellent written and verbal communication skills
• Knowledge of PA Act 146, Appendix H and medical necessity criteria
• Strong interpersonal skills
• Thorough knowledge of DBH and DHS systems and services

Work Conditions (including travel, overtime required, physical requirements and occupational exposure):

• 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.

CBHoffersarobustcompensationandbenefitspackage,including:

• FamilyPlanning,Fertility,AdoptionBenefits
• 403BRetirementPlan
• PTODays/SickDays
• WellnessProgram
• EmployeeAssistanceProgram
• Medical,PrescriptionDrugInsurance
• TuitionReimbursement
• Flexible Spending

Philadelphia Residency Requirement:

• The successful candidate must be a current Philadelphia resident or become a resident within six months of hire.

U.S. Authorization Requirement:

• CBH does not provide sponsorship for applicants requiring future work authorization. All candidates must be legally authorized to work in the United States without requiring sponsorship now or in the future.
• We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CBH is an equal opportunity employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on all qualified individuals. This is without regard to race, ethnicity, creed, color, religion, national origin, age, sex/gender, marital status, gender identity, sexual orientation, gender identity or expression, disability, protected veteran status, genetic information or any other characteristic protected individual genetic information, or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function by applicable federal, state, or local law.

Requesting An Accommodation:

• CBH is committed to providing equal employment opportunities for individuals with disabilities or religious observance, including reasonable accommodation when needed. If you are hired by CBH and require an accommodation to perform the essential functions of your role, you will be asked to participate in our accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodation once hired.

Review, document and process all levels of complaints and grievances plete 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.