The successful candidate will be responsible for overseeing grievance and appeal reviews, as
well as conducting cultural and linguistic reviews for our subcontractors to ensure alignment
with our commitment to diversity and inclusion. This role will provide support to department on
promoting health equity within our organization and in the community, ensuring fair and just
access to healthcare services for all members.

▪ Conduct thorough reviews of grievances and appeals submitted by members to ensure
compliance with regulatory requirements and company policies.
▪ Ensure timely trainings for practitioners pertaining to grievances that are determined to
be discriminatory
▪ Evaluate the cultural and linguistic competency of subcontractors and provide
recommendations for improvement to enhance service delivery to diverse populations.
▪ Monitors accreditation, contractual, legal, and regulatory requirements for cultural and
linguistic services
▪ Collaborate with internal teams to address and resolve member complaints in a timely
and efficient manner.
▪ Develop and implement training programs to educate staff and subcontractors on cultural
sensitivity and effective communication strategies.
▪ Maintains department files for auditing purposes (hard and soft copies) per instruction.
▪ Provides support to champion health equity initiatives within the managed care system to
address disparities in healthcare access and outcomes.
▪ Other duties as assigned

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$85,173.51 - $106,466.89

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.