Complaints Specialist (RN)

Freddie Mac; United States; Remote; USD 65,000 - 80,000; Full time

Job summary

A leading company in behavioral health is seeking a Complaints Specialist to manage quality of care complaints and incidents. The role requires strong analytical and communication skills, with a focus on improving healthcare outcomes. The position offers competitive compensation, full health benefits, and opportunities for professional growth in a remote work environment.

Benefits

Full Health Benefits

401(k) with employer match

Paid time off for volunteering

Tuition reimbursement

Qualifications

• 3+ years post licensure healthcare experience.
• 1+ year of experience in quality management principles.
• Strong written communication skills.

Responsibilities

• Process and document complaints and grievances.
• Manage assigned projects and analyze data.
• Assist with accreditation preparation.

Skills

Communication

Critical thinking

Analytical skills

Flexibility

Problem Solving

Education

BSN/RN License

Tools

Microsoft Office

Visio

Job description

Who We Are

At Lucet, we are industry leaders in behavioral health, dedicated to helping people live healthy, balanced lives. Our purpose is to advocate for and improve the overall well-being of those we serve, through balanced treatment of the mind and body.

When you join Lucet, you become a valued member of our team, serving more than 15 million people across the U.S. Our employees have a passion for helping others - and it shows. From entry-level employees to senior leaders, we are inspired by our members, putting them first in everything we do. From day one, you'll see firsthand the impact you have on our members, knowing you can make a true difference in their lives.

Why join our team at Lucet?

We are a team of collaborative and hard-working professionals working to improve behavioral health outcomes working in a fast-paced and changing environment. At Lucet, no two days are the same. If you find joy in meaningful work and delivering excellent results, we encourage you to apply!

We are looking for top-tier skills and experience in our remote-work environment and that's because we offer top-tier compensation and benefits, which include:

• Annual compensation between $65,000 - $80,000, PLUS an annual performance-based, discretionary incentive. Compensation is dependent on non-discriminatory factors including but not limited to an applicant's skills, education/degrees, certifications, prior experience, market data, and other relevant factors.
• Full Health Benefits - Medical, Dental, and Vision
• 401(k) with competitive employer match
• Company paid life and disability insurance, wellbeing incentives, and parental leave
• Professional development opportunities and tuition reimbursement
• Paid time off including paid time off for volunteering
• Opportunity for meaningful growth, both personally and professionally, where your unique background and experience is welcomed and valued.

What You Will Do - Essential Functions

The Complaints Specialist is responsible for the processing of quality of care complaints, grievances and incidents. Duties include all aspects of clinical quality of care complaint and incident investigations including documentation, interviews, obtaining responses from providers or facilities, reviewing medical records, staffing findings with the medical director, and resolution processes. This position requires knowledge of standards of care, identification of trends and include audit activity of medical records. The CQS is responsible for clearly written reports, and monitoring compliance.

• Complaint and Incident Management: Process and document complaints, grievances, and incidents. Investigate and resolve complaints professionally, confidentially, and collaboratively. Review patient medical records to investigate complaints and incidents. Communicate quality of care issues to management.
• Project and Performance Management: Manage assigned projects: develop, design, analyze, direct, and present. Identify opportunities for improvement and address gaps. Participate in multidisciplinary workgroups and committee meetings. Perform data collection and analyses for reports and audits. Prepare and present reports for various stakeholders.
• Compliance and Accreditation: Assist with accreditation preparation and report development. Coordinate accreditation projects with other departments. Participate in regional performance improvement initiatives.

Who You Are

• Required Qualifications


• Ability to pass background check upon hire and throughout employment to include criminal felony
  & misdemeanor search, SSN validation/trace search (LEIE), education report (highest degree
  obtained), civil upper and lower search, 7-year employment report, federal criminal search,
  statewide criminal search, widescreen plus national criminal search, health care sanctions-state
  med (SAM), national sex offender registry, prohibited parties (OFAC) (terrorist watchlist), and a 9-
  Panel Drug Screen.
• Unencumbered license to practice independently as an BSN/RN.
• 3+ years post licensure healthcare experience with in-home primary or longitudinal care.
• 1+ year of experience working with quality management principles, study design, data analysis, and report preparation.
• 1+ years experience in medical record review, interpreting medical cases with a cognitive understanding of evidence - based standards and medical practice.
• Strong written communication skills including routine ability to compose correspondence, memos,
  and reports, with text tables and graphics as required.
• Intermediate skills with Microsoft Office (Word, Excel, Power Point and Outlook) and Visio
• Critical thinking and analytical skills; able to decipher best practice research with statistical
  discrimination, design audits and surveys.


• Someone who embodies our values by:


• Serving everyone with compassion and leading with empathy.
• Stepping up and creating value by taking charge and acting when there is an opportunity.
• Adapting in a changing world by recognizing our responsibility to be agile and respond quickly.
• Nurturing growth and belonging by respecting and celebrating everyone for who they are.


• Competencies


• Serve everyone with compassion and lead with empathy.
• Step up and creating value by taking charge and acting when there is an opportunity.
• Adapt in a changing world by recognizing our responsibility to be agile and respond quickly.
• Nurturing growth and belonging by respecting and celebrating everyone for who they are.
• Responsible with a high level of integrity and ethical standards
• Intuitive nature to identify compliance irregularities
• Empathy
• Critical thinking
• Flexibility
• Ability to multi-task
• Highly organized and detail-oriented
• Adaptable to various software programs
• Actively participate in and positively contribute to team processes and lead team activities
• Problem Solving


• Working Conditions:


• Work is performed from home with company-provided equipment. Sitting for long periods of time is expected and use of fingers and hands for typing is necessary.
• A quiet workspace with minimal background noise for calls.
• High-speed internet service (cable or fiber optic) with minimum download Speed of 20 Mbps, Upload Speed of 5 Mbps, and Maximum Latency of 100 milliseconds (must be installed before starting).


We encourage applicants with a range of experiences who can demonstrate how their qualifications and skills align with the requirements of this role.

This position will accept and review new applications and resumes no less than 5 business days after the original posting date and may remain open an extended period of time with no set end date based on the level of interest.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.