The Grievances & Appeals Coordinator core function includes responsibility for informing and educating plan members and practitioners on the process to properly submit a formal grievance and/or appeal. The incumbent of this position manages, investigates and resolves member and practitioner grievances/appeals, to include appeals related to medication medical or service denials pursuant to Virginia Premier Health Plan’s (VPHP) and Virginia Premier CompleteCare (VPCC) policies and procedures, its regulatory and its accreditation requirements to include, but not limited to, meeting all required timeframes. The Grievances & Appeals Coordinator shall also be responsible for serving as the plan’s expert and liaison for the members and practitioners related to all grievance and appeals activities. Minimum travel may be required.
MINIMUM EDUCATION REQUIREMENTS
SPECIAL KNOWLEDGE AND/OR SKILLS
Physical health sufficient to meet the ergonomic standards and demands of the position.
Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs. Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia.
We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.
All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE
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