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. 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.
Application Link: https://www.capitalhealth.com/Capital-Health-Plan/Contact-Us/Employment-at-CHP
Close Date: 01/31/2018