Grievance Coordinator at Chaparral Medical Group — Ontario

About The Role

&lt;div class=&quot;content-intro&quot;&gt;&lt;p&gt;&lt;strong&gt;Company Overview&lt;br&gt;&lt;/strong&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;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, &lt;/span&gt;&lt;a href=&quot;https://www.globenewswire.com/en/news-release/2022/09/08/2512660/0/en/Technology-Company-Akido-Labs-Launches-New-Medical-Network-Focused-on-Preventive-Care-for-Chronic-Disease.html&quot;&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;CMG joined forces with Akido Labs&lt;/span&gt;&lt;/a&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;, 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.&amp;nbsp;&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;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. &lt;/span&gt;&lt;span style=&quot;font-weight: 400;&quot;&gt;We&#39;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&lt;/span&gt;&lt;/p&gt;&lt;/div&gt;&lt;p&gt;&lt;strong&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Position Summary&lt;/span&gt;&lt;/strong&gt;&amp;nbsp;&lt;/p&gt;
&lt;p&gt;&lt;span data-contrast=&quot;auto&quot;&gt;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.&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span data-contrast=&quot;auto&quot;&gt;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.&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span data-contrast=&quot;auto&quot;&gt;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.&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;strong&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Essential Functions&lt;/span&gt;&lt;/strong&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Serve as the primary coordinator for all health plan grievances, complaints, and member concerns received across the region. &lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Receive, review, investigate, and respond to grievances within required regulatory and contractual timelines.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Collaborate with clinic leaders, providers, departments, and operational teams to gather information needed for grievance investigations.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Prepare clear, accurate, and professional written responses to health plans regarding member complaints and grievances.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Review medical records, documentation, policies, procedures, and operational processes to support investigations.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Ensure grievance responses meet health plan, CMS, state, delegated entity, and organizational requirements.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Maintain detailed records of grievance investigations, findings, corrective actions, and resolutions.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Monitor grievance deadlines and ensure timely submission of responses and supporting documentation.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Identify trends, recurring issues, and operational concerns through grievance analysis.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Escalate high-risk, regulatory, compliance, or quality concerns to leadership as appropriate.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Coordinate with Patient Relations, Quality, Compliance, and Clinical Operations teams to implement corrective actions.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Participate in audits and prepare documentation for health plan reviews and regulatory requests. &lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Maintain confidentiality and compliance with HIPAA and privacy regulations.&lt;/span&gt; &amp;nbsp;&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&lt;strong&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Key Responsibilities&lt;/span&gt;&lt;/strong&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Manage the grievance process from receipt through resolution for all assigned health plans and clinics. &lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Track and prioritize multiple grievance cases while ensuring compliance with turnaround time requirements.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Draft professional grievance response letters and health plan communications.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Conduct routine follow-up with clinic leadership and stakeholders regarding open grievance investigations.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Maintain grievance logs, databases, reporting tools, and supporting documentation.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Ensure complete, accurate, and timely documentation of all grievance activities.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Analyze grievance trends and identify opportunities for process improvement and member satisfaction enhancements. &lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Assist leadership in developing corrective action plans related to grievance findings.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Prepare recurring reports and dashboards related to grievance volume, timeliness, outcomes, and trends.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Participate in health plan meetings and delegated oversight activities as assigned.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Provide education and guidance to clinic staff regarding grievance management processes and best practices.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Support patient experience initiatives by identifying barriers impacting member satisfaction.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Collaborate with operational and clinical leaders to address systemic issues contributing to grievances.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Maintain current knowledge of health plan requirements, regulatory updates, and industry best practices.&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&lt;strong&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Required Qualifications&lt;/span&gt;&lt;/strong&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;High School Diploma or equivalent required. &lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Minimum of one (1) year of healthcare operations, patient relations, grievance management, quality, compliance, or health plan experience.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Experience investigating and responding to patient complaints, grievances, or regulatory inquiries.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Knowledge of managed care, healthcare operations, regulatory compliance, and health plan requirements.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Strong written communication skills with the ability to draft professional and detailed correspondence.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Excellent organizational and time management skills.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Ability to manage multiple projects and deadlines simultaneously.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Proficiency with electronic health records (EHR), Microsoft Office Suite, and reporting systems.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Strong analytical, problem-solving, and investigative skills.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Ability to maintain confidentiality and exercise sound judgment when handling sensitive information.&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;strong&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Preferred Qualifications&lt;/span&gt;&lt;/strong&gt;&amp;nbsp;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Experience working with Medicare, Medicaid, Commercial Health Plans, or Delegated Medical Groups. &lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Prior experience in grievance and appeals management.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Knowledge of CMS, DHCS, NCQA, and health plan grievance requirements.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Experience with quality improvement and performance improvement initiatives.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Experience preparing regulatory responses and corrective action plans.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&lt;strong&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Physical Requirements:&lt;/span&gt;&lt;/strong&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li data-leveltext=&quot;&quot; data-font=&quot;Symbol&quot; data-listid=&quot;1&quot; data-list-defn-props=&quot;{&amp;quot;335552541&amp;quot;:1,&amp;quot;335559685&amp;quot;:720,&amp;quot;335559991&amp;quot;:360,&amp;quot;469769226&amp;quot;:&amp;quot;Symbol&amp;quot;,&amp;quot;469769242&amp;quot;:[8226],&amp;quot;469777803&amp;quot;:&amp;quot;left&amp;quot;,&amp;quot;469777804&amp;quot;:&amp;quot;&amp;quot;,&amp;quot;469777815&amp;quot;:&amp;quot;hybridMultilevel&amp;quot;}&quot; data-aria-posinset=&quot;1&quot; data-aria-level=&quot;1&quot;&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Ability to sit and/or stand for prolonged periods of time.&lt;/span&gt;&lt;/li&gt;
&lt;li data-leveltext=&quot;&quot; data-font=&quot;Symbol&quot; data-listid=&quot;1&quot; data-list-defn-props=&quot;{&amp;quot;335552541&amp;quot;:1,&amp;quot;335559685&amp;quot;:720,&amp;quot;335559991&amp;quot;:360,&amp;quot;469769226&amp;quot;:&amp;quot;Symbol&amp;quot;,&amp;quot;469769242&amp;quot;:[8226],&amp;quot;469777803&amp;quot;:&amp;quot;left&amp;quot;,&amp;quot;469777804&amp;quot;:&amp;quot;&amp;quot;,&amp;quot;469777815&amp;quot;:&amp;quot;hybridMultilevel&amp;quot;}&quot; data-aria-posinset=&quot;1&quot; data-aria-level=&quot;1&quot;&gt;Ability to move/carry objects up to 20 pounds.&lt;/li&gt;
&lt;li data-leveltext=&quot;&quot; data-font=&quot;Symbol&quot; data-listid=&quot;1&quot; data-list-defn-props=&quot;{&amp;quot;335552541&amp;quot;:1,&amp;quot;335559685&amp;quot;:720,&amp;quot;335559991&amp;quot;:360,&amp;quot;469769226&amp;quot;:&amp;quot;Symbol&amp;quot;,&amp;quot;469769242&amp;quot;:[8226],&amp;quot;469777803&amp;quot;:&amp;quot;left&amp;quot;,&amp;quot;469777804&amp;quot;:&amp;quot;&amp;quot;,&amp;quot;469777815&amp;quot;:&amp;quot;hybridMultilevel&amp;quot;}&quot; data-aria-posinset=&quot;1&quot; data-aria-level=&quot;1&quot;&gt;Moving from one work site to another as needed.&lt;/li&gt;
&lt;li data-leveltext=&quot;&quot; data-font=&quot;Symbol&quot; data-listid=&quot;1&quot; data-list-defn-props=&quot;{&amp;quot;335552541&amp;quot;:1,&amp;quot;335559685&amp;quot;:720,&amp;quot;335559991&amp;quot;:360,&amp;quot;469769226&amp;quot;:&amp;quot;Symbol&amp;quot;,&amp;quot;469769242&amp;quot;:[8226],&amp;quot;469777803&amp;quot;:&amp;quot;left&amp;quot;,&amp;quot;469777804&amp;quot;:&amp;quot;&amp;quot;,&amp;quot;469777815&amp;quot;:&amp;quot;hybridMultilevel&amp;quot;}&quot; data-aria-posinset=&quot;1&quot; data-aria-level=&quot;1&quot;&gt;Ability to communicate with others to exchange information&lt;/li&gt;
&lt;li data-leveltext=&quot;&quot; data-font=&quot;Symbol&quot; data-listid=&quot;1&quot; data-list-defn-props=&quot;{&amp;quot;335552541&amp;quot;:1,&amp;quot;335559685&amp;quot;:720,&amp;quot;335559991&amp;quot;:360,&amp;quot;469769226&amp;quot;:&amp;quot;Symbol&amp;quot;,&amp;quot;469769242&amp;quot;:[8226],&amp;quot;469777803&amp;quot;:&amp;quot;left&amp;quot;,&amp;quot;469777804&amp;quot;:&amp;quot;&amp;quot;,&amp;quot;469777815&amp;quot;:&amp;quot;hybridMultilevel&amp;quot;}&quot; data-aria-posinset=&quot;1&quot; data-aria-level=&quot;1&quot;&gt;Ability to use and/or type on a laptop/keyboard.&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;&lt;div class=&quot;content-pay-transparency&quot;&gt;&lt;div class=&quot;pay-input&quot;&gt;&lt;div class=&quot;title&quot;&gt;Hourly pay range&lt;/div&gt;&lt;div class=&quot;pay-range&quot;&gt;&lt;span&gt;$28&lt;/span&gt;&lt;span class=&quot;divider&quot;&gt;&amp;mdash;&lt;/span&gt;&lt;span&gt;$34 USD&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;/div&gt;&lt;div class=&quot;content-conclusion&quot;&gt;&lt;p&gt;Chaparral Medical Group and Akido MSO are an equal opportunity employers, and we encourage qualified applicants of every background, ability, and life experience to contact us about appropriate employment opportunities.&lt;/p&gt;&lt;/div&gt;