Grievance Coordinator

chaparralmedicalgroup; Ontario (CA); On-site; USD 60,000 - 80,000; Full time

Job summary

The Grievance Coordinator at Chaparral Medical Group is responsible for the management, investigation, documentation, and resolution of health plan grievances, complaints, appeals support, and regulatory inquiries for clinics across the region.

This role serves as the central point of contact for grievance communications, ensuring timely, accurate, and compliant responses in line with federal, state, health plan, and organizational requirements.

Responsibilities

• Manage the grievance process from receipt through resolution for all assigned health plans and clinics.
• Track and prioritize multiple grievance cases while ensuring compliance with turnaround time requirements.
• Draft professional grievance response letters and health plan communications.
• Conduct routine follow-up with clinic leadership and stakeholders regarding open grievance investigations.
• Maintain grievance logs, databases, reporting tools, and supporting documentation.
• Ensure complete, accurate, and timely documentation of all grievance activities.
• Analyze grievance trends and identify opportunities for process improvement and member satisfaction enhancements.
• Assist leadership in developing corrective action plans related to grievance findings.
• Prepare recurring reports and dashboards related to grievance volume, timeliness, outcomes, and trends.
• Participate in health plan meetings and delegated oversight activities as assigned.
• Provide education and guidance to clinic staff regarding grievance management processes and best practices.

Job description

Company Overview

Over the past 40 years, Chaparral Medical Group (CMG) has established itself as a leading primary and multi-specialty care provider for California's Inland Empire. In 2022, CMG joined forces with Akido Labs , a tech-enabled healthcare company, to transform the healthcare experience from the ground up. This partnership joins CMG's medical services with Akido's innovative technology to relieve the frustrations felt by everyone involved in care delivery, from medical providers and their staff, to the patients and their families. Ultimately, this means our providers spend more time caring for patients and less time bogged down with administrative work.

As part of the Akido medical network, we are currently responsible for more than 250,000 patients in Southern California, with plans to expand into new markets across the U.S. We care deeply about the communities we serve and are committed to providing accessible, high quality healthcare that helps our patients and communities live their fullest lives. We're building a dynamic, diverse and driven team as we continue to grow and broaden our impact. We are seeking passionate people who care deeply about helping patients and communities. We hope you'll join our team

Position Summary

The Grievance Coordinator is responsible for the management, investigation, documentation, and resolution of all health plan grievances, complaints, appeals support, and regulatory inquiries for clinics across the region. This role serves as the central point of contact for health plan grievance communications and ensures timely, accurate, and compliant responses in accordance with federal, state, health plan, and organizational requirements. The Grievance Coordinator partners closely with clinic leadership, providers, operations teams, patient relations, quality, compliance, and health plans to investigate concerns, gather supporting documentation, identify root causes, and prepare comprehensive grievance responses. The position plays a critical role in maintaining regulatory compliance, improving patient satisfaction, identifying operational opportunities for improvement, and strengthening relationships with health plan partners. The ideal candidate possesses strong investigative skills, exceptional written communication abilities, healthcare operations knowledge, and the ability to manage multiple deadlines in a fast-paced environment.

Essential Functions

• Serve as the primary coordinator for all health plan grievances, complaints, and member concerns received across the region.
• Receive, review, investigate, and respond to grievances within required regulatory and contractual timelines.
• Collaborate with clinic leaders, providers, departments, and operational teams to gather information needed for grievance investigations.
• Prepare clear, accurate, and professional written responses to health plans regarding member complaints and grievances.
• Review medical records, documentation, policies, procedures, and operational processes to support investigations.
• Ensure grievance responses meet health plan, CMS, state, delegated entity, and organizational requirements.
• Maintain detailed records of grievance investigations, findings, corrective actions, and resolutions.
• Monitor grievance deadlines and ensure timely submission of responses and supporting documentation.
• Identify trends, recurring issues, and operational concerns through grievance analysis.
• Escalate high-risk, regulatory, compliance, or quality concerns to leadership as appropriate.
• Coordinate with Patient Relations, Quality, Compliance, and Clinical Operations teams to implement corrective actions.
• Participate in audits and prepare documentation for health plan reviews and regulatory requests.
• Maintain confidentiality and compliance with HIPAA and privacy regulations.

Key Responsibilities

• Manage the grievance process from receipt through resolution for all assigned health plans and clinics.
• Track and prioritize multiple grievance cases while ensuring compliance with turnaround time requirements.
• Draft professional grievance response letters and health plan communications.
• Conduct routine follow-up with clinic leadership and stakeholders regarding open grievance investigations.
• Maintain grievance logs, databases, reporting tools, and supporting documentation.
• Ensure complete, accurate, and timely documentation of all grievance activities.
• Analyze grievance trends and identify opportunities for process improvement and member satisfaction enhancements.
• Assist leadership in developing corrective action plans related to grievance findings.
• Prepare recurring reports and dashboards related to grievance volume, timeliness, outcomes, and trends.
• Participate in health plan meetings and delegated oversight activities as assigned.
• Provide education and guidance to clinic staff regarding grievance management processes and best practices.
• Support patient experience initiatives by identifying barrier