What are the responsibilities and job description for the Grievance and Regulatory Manager position at Capital Health Plan?
Location: Centerville Road
Area/Department: Care Coordination
F/T or P/T status: Full-time
Schedule/Hours: As Required
Job Summary:
Provides oversight for grievance/appeal and organizational determinations which includes accountability within the department for monitoring compliance with all federal and state regulations including CMS, and NCQA accreditation standards. Actively participates in the daily activities related to grievance/appeals. Creates, maintains, and prepares required reports to meet company and regulatory requirements for grievance, appeals, and organizational determinations.
Minimum Qualifications:
Licensed Medical Professional in the State of Florida. Bachelor's degree from four year college or university or one to two years' related experience and/or training; or equivalent combination of education and experience. Skilled in use of Microsoft office and database software. Must occasionally lift and/or move up to 25 pounds.
Other Qualifications:
Preference will be given to candidates with one or more of the following: (1) in depth knowledge of regulatory and accreditation requirements for grievance, appeal and UM procedures, and (2) knowledge and understanding of clinical patient care.