Grievance Coordinator
Core
Manage, investigate, document, and resolve health plan grievances, complaints, appeals, and regulatory inquiries for clinics across California, Rhode Island, and New York.
Role type
Healthcare operations coordinator (grievance management)
Builds
Compliant grievance responses and corrective action plans for health plans and regulatory bodies
Domain
Healthcare operations / Managed care / Regulatory compliance
Deliverable
dashboards & analysis
Required skills
Grievance management, Regulatory compliance, Medical record review, Written communication, Trend analysis, HIPAA compliance
Preferred skills
Medicare/Medicaid experience, CMS/DHCS/NCQA knowledge, Quality improvement initiatives
Technologies
EHR, Microsoft Office Suite, Reporting systems
Responsibilities
Receive, review, investigate, and respond to grievances within regulatory timelines; Collaborate with clinic leaders and operational teams to gather investigation data; Draft professional response letters to health plans; Maintain detailed logs and databases of grievance activities; Analyze trends to identify process improvement opportunities; Prepare recurring reports on grievance volume and outcomes; Escalate high-risk compliance concerns to leadership.
Seniority
Entry-level, hands-on IC