ABOUT THIS TEMP POSITION
We have opportunities to join the Alliance as a Temporary Grievance Coordinator in the Member Services Department. These positions require in-office presence in either our Merced or Scotts Valley office (hybrid).
This is a temporary position with an estimated duration of 3-6 months. The length of the assignment depends on business needs and may change. If selected, you will be employed by a temporary employment agency connected with us, while working at the Alliance.
WHAT YOU'LL BE RESPONSIBLE FOR
Reporting to the Grievance Supervisor, this position:
- Assists in the administration and resolution of low complexity cases supporting the Alliance Grievance function.
- Performs administrative duties to track, organize, monitor, and follow up on case work.
- Participates in departmental and cross-departmental trainings, workgroups, and operational improvement activities.
- Performs other duties as assigned.
ABOUT THE TEAM
Grievance work involves complex coordination, investigation, and resolution within regulatory timeframes. Areas include:
- Appeals: Member complaints involving adverse benefit determinations by an Alliance Utilization Management decision.
- Member Grievances: Complaints expressed by members or their authorized representatives dissatisfaction with any aspect of the health care plan.
- Expedited Appeals/Grievances: Urgent complaints involving imminent and serious threats to a members health, such as severe pain or potential loss of life.
- State Fair Hearings: Requests by Medi-Cal members for DSS to resolve plan decision issues.
- Inquiries: Questions or requests for information from members that do not involve dissatisfaction.
- Billing Issues or Reimbursements: Issues related to bills from medical providers or out-of-pocket payments for covered services.
WHAT YOU'LL NEED TO BE SUCCESSFUL
To read the full position description and list of requirements, click here.
- Knowledge of:
- Principles and practices of managed healthcare, coverage, and benefit structures.
- Title 22 and Title 28 regulations related to utilization management and grievances.
- The needs of the Medi-Cal population.
- Customer service principles and practices.
- Ability to:
- Understand and communicate complex operations of the Alliance, especially in Utilization Management, Care Management, and Member Services.
- Use internal tracking systems.
- Draft professional correspondence.
- Learn and use computer systems and effectively communicate the program's mission, vision, and roles.
- Education and Experience:
- Associate's degree in health, social services, or a related field, and one year of experience in a managed health care setting, or an equivalent combination of education and experience.
OTHER INFORMATION
- Hybrid work environment; interviews will be conducted remotely via Microsoft Teams.
- Attendance at quarterly company-wide or department meetings may be required.
- In-office or community presence may be needed based on business needs, to be discussed during the interview.
Pay Range: Santa Cruz County: $24.61$32 USD; Merced County: $22.40$29.12 USD
OUR BENEFITS
Available for all regular employees working more than 30 hours/week. Benefits are not available to temporary employees during their assignment.
- Medical, Dental, and Vision Plans
- Paid Time Off
- 12 Paid Holidays
- Retirement and Deferred Compensation Plans
- Health and Wellness Programs
- Onsite EV Charging Stations
ABOUT US
We are over 500 employees committed to providing accessible, quality health care guided by local innovation. We serve members across several counties and aim to make a positive community impact.
Join us at Central California Alliance for Health, where our culture is respectful, diverse, and empowering. We are an equal opportunity employer and participate in E-Verify. Currently, we do not sponsor work visas; applicants must be authorized to work in the U.S. full-time without sponsorship.
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