Description

　　::: {#textEditorContainer23 title=""}::: {#textEditor22 contenteditable="false" noto="" sans",="" sans-serif;="" font-size:="" 14pt;="" line-height:="" 1.42857;="" width:="" auto;="" margin-left:="" 0px;"=""}PRINCIPAL RESPONSIBILITIES:

　　Under general direction of the Grievance and Appeals Leadership, the Grievance and Appeals (GandA) Coordinator II will review, investigate and process non-complex grievances for all lines of business and the completion of written communication documents to convey determination. The Coordinator is responsible for processing and monitoring the grievance process and corresponding documentation continuously for quality and accuracy while working independently within a team environment.

　　Principal responsibilities include:

　　Address and respond to telephonic and written inquiries regarding member non-complex grievances ensuring correct identification and categorization of one or more issues raised by the member, members representative or provider on behalf of member.

　　Independently investigate, research, review, and resolve non-complex

　　grievances within regulated timeframes, while clarifying issues and educating members in the process.

　　Perform research and identify key policy provisions such as clinical guidelines, plan policies, EOC, regulatory guidelines, and DMHC/DHCS rules and regulations.

　　Interpret member contracts, internal policies, and procedures as well as regulatory and accreditation requirements.

　　[[Frequently communicate with members from intake to completion of a case.]{mce-=""}]{mce-=""}::::::