Complaints & Grievances SpecialistCBH 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/ARelevant 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
- Excellent customer service skills
- Excellent training & facilitating skills
- 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.
CBH offers a robust compensation and benefits package, including:
Family Planning, Fertility, Adoption Benefits403B Retirement PlanPTO Days/Sick Days
Wellness Program
Employee Assistance Program
Health, Dental, Vision Insurance
Medical, Prescription Drug Insurance
Tuition Reimbursement
Commuter Benefits
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.
Equal Employment Opportunity:
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. If you would like to be considered for employment opportunities with CBH and have accommodation needs for a disability or religious observance, please send us an email at CBH.Recruitment@Phila.gov
