Quality Assurance & External Affairs Specialist (Grievance Coordinator)

Quality Assurance and External Affairs Specialist

(Grievance Coordinator)

 

Dental HMO plan seeks a Grievance Coordinator with prior compliance, quality assurance or dental office experience.


POSITION SUMMARY

Primary areas of responsibility include:
1)Member Services Quality Review and Resolution: receives, documents and facilitates the timely investigation and resolution of member complaints or grievances regarding professional service or other issues affecting enrollees, in accordance with established internal policies and procedures and external regulatory agency requirements;

2)Professional Services Quality Assurance: coordinates, records and maintains accurate and up-to-date policies and procedures for continuous review of the quality of care and performance of affiliated dentists and their staff. Identify, investigate and resolve potential quality of care issues, including the identification, tracking and trending of systemic quality of care issues and the establishment of performance improvement goals;

3)External Affairs: documents and maintains policies and procedures to insure compliance with external regulatory agency rules and regulations; participates in Department of Managed Health Care (DMHC) training programs and routine dental surveys in areas relating to quality assurance, utilization review, grievance, appeals and metric systems, access and availability of services; prepares and submits DMHC filings, as required; and

4)Available and supporting any and all other company initiatives.

5)Responsible for results.

REQUIREMENTS

•2-4 years compliance experience in a regulatory environment
•Bachelor's degree preferred
•Previous dental office/plan experience helpful
•CADP certified helpful, but not required
•Excellent written and oral communication skills
•Customer service and sales experience helpful
•Detail-oriented
•Self-starter
•Problem-solver
•Organized
•Intermediate MS Word, Excel and Outlook skills
•Experience with ACT! helpful, but not required

A great attitude and a willingness to help others will be rewarded in this specialized healthcare company. In addition to your base salary, we offer excellent medical, dental and disability benefits, including performance based compensation and 401k participation. To be considered for this position please email your resume and cover letter.

We look forward to having you on our team!

 

No Phone Calls, Please.