Quality Complaint and Member Experience Coordinator
: Job Details :

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Come join Peak Health where you will help to build a health plan from the ground up as the Quality Complaint and Member Experience Coordinator. Reporting to the Manager of Care Management, the Quality Complaint and Member Experience Coordinator will be an integral member of the health plan's medical management team. The Quality Complaint and Member Experience Coordinator will receive and provide end-to-end management of complaints and grievances that are expressed by a member, member representative, Health Plan staff, or affiliated practitioner/provider. In addition, the incumbent of this role will coordinate the member experience vendor contract activities, oversee the distribution of member surveys, and lead the development of action plans to increase member satisfaction. The Quality Complaint and Member Experience Coordinator will work in matrix with other managers across Peak Health, as well as serve as a liaison to the Provider Network, to ensure that the highest level of quality of care is maintained.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor's degree

EXPERIENCE:

1. One (1) year of experience working in member/patient experience or management of member/patient complaints and grievances.

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Certification in area of expertise emphasizing the ongoing commitment to continuous learning.

EXPERIENCE:

1. At least three years of patient care experience in either a hospital or health plan setting.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Manages the end-to-end process of complaints and grievances resolution.

2. In collaboration with other members of the Peak Health Management team, works to ensure that complaints and grievances are managed timely.

3. Able to articulates and understands regulatory definitions and requirements within 60 days of hire.

4. Coordinates, monitors, improves, and reports on the progress of cases. Tracks and trends opportunities for improvement with internal and external key stakeholders.

5. Effectively communicates with internal and external stakeholders.

6. Provides functional support to the complaints and grievances clinical review team members.

5. Leads the ongoing cross-functional performance improvement activities related to complaints, grievances, and member experience.

7. Ensures compliance with all state and federal regulatory bodies as well as accreditation agencies.

8. Responsible for implementation of member satisfaction surveys and composing reports as needed to ensure member satisfaction success

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office environment

SKILLS AND ABILITIES:

1. Demonstrated knowledge of federal and state laws, NCQA and industry regulations for the management of complaints, grievances, and reporting and improvement of member experience data.

2. Excellent written and oral communication

3. Problem solving capabilities to lead change management

4. Attention to detail

5. Proficiency with the Microsoft Office suite on hire

6Proficiency with the EPIC tapestry system within 90 days of hire.

Additional Job Description:

Hybrid position (Morgantown, WV)

Day shift, Monday - Friday

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Non-Exempt)

Company:

PHH Peak Health Holdings

Cost Center:

2403 PHH Medical Management

Address:

1085 Van Voorhis Rd

Morgantown

West Virginia

WVU Medicine is proud to be an Equal Opportunity employer. We value diversity among our workforce and invite applications from all qualified applicants regardless of race, ethnicity, culture, gender, sexual orientation, sexual identity, gender identity and expression, socioeconomic status, language, national origin, religious affiliation, spiritual practice, age, mental and physical ability/disability or Veteran status.