Remote Grievance & Compliance Specialist

Detroit Wayne Integrated Health Network; United States; On-site; USD 42,000 - 64,000; Full time

Job summary

Detroit Wayne Integrated Health Network is hiring a Customer Service Grievance Specialist to ensure the grievance process complies with local, state, and federal regulations, MDHHS contracts, and mental health codes.

Under the general supervision of the Director of Customer Service, you will develop procedures, provide information and referrals, monitor inquiries, and prepare regular grievance reports for internal and external stakeholders.

Qualifications

• Understanding of grievance processes and related regulations.
• Ability to interpret state and federal guidelines.
• Strong documentation and reporting skills.
• Confidential handling of sensitive information.
• Ability to train staff on grievance procedures.

Responsibilities

• Assist with development of grievance process and procedures in accordance with Federal Rules, MDHHS guidelines, Michigan Mental Health Code and DWIHN policies and procedures.
• Provide applicable Customer Service information, referral, and linkage.
• Provide oversight of telephone and walk-in inquiries.
• Assist with the monitoring of the grievance process at DWIHN and contractor network to ensure compliance with established policies and procedures.
• Collaborate and coordinate with various internal/external entities to ensure that issues are addressed in accordance with mandated policies and procedures.
• Maintain the reporting mechanism that tracks and monitors DWIHN and contractor’s network complaints and grievances.
• Assist in the review and analysis of grievance data for reporting of trends and patterns.
• Assist in the preparation of weekly, monthly, quarterly, and annual DWIHN, ICO and MDHHS reports on grievance activity.
• Provide technical assistance to DWIHN staff and contractors on grievance protocol and applicable dispute resolution protocols.
• Develops and implements on-going grievance training modules specific to applicable audiences i.e., DWIHN staff, contracted providers, enrollees, and family members.
• Assists in the development and maintenance of standardized grievance educational and informational materials (i.e. handbook, posters, forms, policies etc.).
• Attends periodic meetings within DWIHN and/or the community to address DWIHN’s issues and updates that are applicable to grievance activities.
• Fosters a climate of collaboration and innovation to improve upon community integration and wellness outcomes among individuals who receive services.
• Performs related duties as assigned.

Skills

Excellent written and verbal comms

Analytical skills

Investigation skills

Time management

Multitasking

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Outlook

Teams

Access

Job description

Detroit Wayne Integrated Health Network is hiring a Customer Service Grievance Specialist to ensure the grievance process complies with local, state, and federal regulations, MDHHS contracts, and mental health codes.

Under the general supervision of the Director of Customer Service, you will develop procedures, provide information and referrals, monitor inquiries, and prepare regular grievance reports for internal and external stakeholders.