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Dental Grievance Coordinator, Quality of Care at Delta Dental of California

Posted in Other 30+ days ago.

Type: Full Time
Location: Alpharetta, Georgia





Job Description:

At Delta Dental, our strategy is only as strong as the people who execute it! We are hiring individuals that are not just right for today but also for our future. We have built a foundation of high-trust by treating all people with dignity, making and keeping commitments, and consistently striving to do the right thing. Our leaders optimistically share future possibilities to inspire and motivate others toward their full potential. We expect our employees to find ways to embrace positive change, be curious and challenge the status quo, and provide solutions to unmet problems. Joining Delta Dental means joining a culture focused on fostering development, building genuine connections, recognizing each other's strengths and sharing in successes.

The Quality of Care Grievance Coordinator is responsible for responding to quality of care and quality of service complaints and oversees the complaint response process to facilitate timely resolutions and responses. How you will make an impact:
- Records all quality of care and quality of service complaints and potential quality referrals initiated by members and internal and/or external clinicians.
- Reviews clinical and medical records for completeness and determines administrative or clinical complaint.
- Performs research and identifies key policy provisions such as clinical guidelines, plan policies, EOC, regulatory guidelines and DMHC/DHCS rules and regulations.
- Summarizes cases including articulation of complainant's perception and presents essential information to Dental Consultant for review.
- Assigns reviews to clinical staff if needed.
- Works with the Clinical Quality Consultants, Dental Consultants and other clinical staff to ensure that clinical issues are appropriately evaluated.
- Prepares case file external (including IRE) review of complaints as appropriate.
- Coordinates on-site assessments and audits.
- Identifies the root causes of complaints and works with the applicable operational departments to implement an appropriate resolution.
- Communicates these resolutions to the complainant via telephone or written correspondence.
- Assists with additional duties as assigned. What we look for:
- Experience working in a dental office preferred.
- 3+ years experience with managed care in government and commercial lines of business.
- 2+ years experience with researching and resolving inquiries regarding quality of care and service.
- 3+ years working in a regulated environment/managed healthcare environment.
- Bachelor's Degree or equivalent years of experience.
- Six Sigma Knowledge/ Green Belt.
- Proficient in using MS Office products including the ability to use Excel to create pivot tables and formulas.
- A passion for changing the healthcare experience for our members.
- You are energized by helping people and seeing the positive impact of your efforts.
- Resourcefulness and enjoyment in solving complicated problems to get to the root cause.
- Excellent written and verbal communication skills.
- Detail-oriented with the ability to conduct research and identify steps required to resolve issues and follow through to completion.
- Experience in customer service, provider service, health service or dental in a managed care or health care environment handling escalated or complex issues.Benefits and perks:
- 12 days starting vacation plus 12 holidays and your birthday off!
- Multiple medical insurance options: 100% paid or low cost premiums
- 100% paid dental insurance
- 100% paid vision insurance
- Onsite gym and/or gym discount and fitness incentive
- Culture of learning: substantial tuition reimbursement to improve your skills
- Career growth: we love promoting from within
- Strong commitment to work/life balance
- Technology allowance
- Social responsibility and volunteer opportunities
Due to COVID-19, there is an even greater demand for flexibility and change. Due to the pandemic, the expectation around work location for certain roles may be remote until a future date, determined by Delta Dental Management. Should the position you seek be determined by Delta Dental Management as \\"remote,\\" the position may require you to have access to remote internet in order to meet the expectations outlined in the job duties.

Please note, Delta Dental will not sponsor applicants for work visas for this position.

#LI-AK1

At Delta Dental we:
Promote accountability, integrity and collaboration: Our employees are collaborative, self-aware, and ethical. It is our expectation to do the right thing and follow through on commitments.
Foster professional development: Our employees take ownership of developing themselves and others through coaching, mentoring and providing/being open to constructive feedback and identifying learning opportunities.
Value customers and cultivate positive experiences: Our employees take time to build rapport with customers, while anticipating and exceeding their needs to ensure positive outcomes.

If you think this sounds like you, let's chat. We would love to tell you more!

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ABOUT Delta Dental
Delta Dental covers more Americans than any other dental benefits provider. Our vision is to motivate and empower every employee so we're all inspired to take exceptional care of our customers, providers and each other. Our Enterprise Strategy focuses on pillars of Growth and Diversification, supported by the platforms of Culture and People, Process and Technology. Our employees take pride working for a purpose-driven organization and live our values of Trust, Service, Excellence and Innovation.

We are part of the Delta Dental Plans Association, a network of companies that provides dental coverage to 74 million people in the U.S. Delta Dental of California, Delta Dental of New York, Inc., Delta Dental of Pennsylvania and Delta Dental Insurance Company, together with our affiliate companies, form one of the nation's largest dental benefits delivery systems, covering 33 million enrollees. All of our companies are members, or affiliates of members, of the Delta Dental Plans Association, a network of 39 Delta Dental companies throughout the country.

Delta Dental provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, genetics, or any other classification protected by federal or state law. In addition to federal law requirements, Delta Dental complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Proof of eligibility to work in the United States must be provided if selected for hire. .


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