Grievances & Appeals Specialist (408388)

IDR is seeking a Grievances & Appeals Specialist (San Francisco) to join one of our top clients in the healthcare sector. This role is pivotal in addressing patient and family concerns, investigating complaints related to care quality, provider actions, and hospital policies. If you are looking for an opportunity to join a large organization and work within a team-oriented culture, please apply today!

Position Overview/Responsibilities for the Grievances & Appeals Specialist (San Francisco):

• Investigate patient and family complaints regarding care quality, provider actions, and policy concerns
• Handle high-complexity cases requiring collaboration across departments
• Work with managers, physicians, and staff to resolve grievances
• Coordinate with Legal and Risk Management on medical-legal matters
• Ensure compliance with CMS Conditions of Participation and organizational grievance policies

Required Skills for Grievances & Appeals Specialist (San Francisco):

• Bachelor's degree in Business Administration, Nursing, Social Work, or a related healthcare field (or equivalent experience)
• Minimum 2 years of recent experience in grievances, appeals, or patient advocacy
• Strong written and verbal communication for patient responses and case documentation
• Analytical ability to conduct medical record reviews and quality-of-care investigations
• Proficiency in word processing, email, database management, and patient care software

What's in it for you?

• Competitive compensation package
• Full Benefits; Medical, Vision, Dental, and more!
• Opportunity to get in with an industry-leading organization
• Close-knit and team-oriented culture

Why IDR?2

• 5+ Years of Proven Industry Experience in 4 major markets
• Employee Stock Ownership Program
• Medical, Dental, Vision, and Life Insurance
• ClearlyRated's Best of Staffing® Client and Talent Award winner 11 years in a row