Complaints & Grievances Behavioral Health Liaison

The Complaints and Grievances Behavioral Health Liaison will be responsible for the scheduling of Second Level Complaints and Grievances in Accordance with PS&R Appendix H.

Essential Functions:

Coordinate with Providers and Members regarding Grievance and Complaint Hearings:

• Contact providers to confirm if member is still in the level of care (loc) that is the subject of the grievance.
• If member is no longer in the loc that is subject of the grievance follow up with the member to determine if they want to continue with the grievance.
• Day prior to the hearing contact both the member and the provider as reminder of the upcoming hearing.

Scheduling Coordinator

• Schedule hearing and send out invitations to all parties.
• Interact and interface with Consumer Advocate agencies and independent peers for the purpose of assigning for upcoming hearings. Additionally for independent advocates complete the monthly invoice for advocate to be compensated.
• Interact and interface with DBHIDS as needed for assignment of County Representatives for Second Level Complaint hearings.
• Interact and interface with Clinical Department for the assignments of physician/psychologist and Clinical Representative for grievances.

Panel Documentation

• Place all relevant documentation in the members grievance or second level complaint folder.
• Send documentation to the panel two business days prior to the hearing.

Point Person for External Grievances and Fair Hearings will be responsible for gathering required documentation and sending to assigned external reviewer.

• Download and request hearing CDs
• Coordinate conference rooms and telecommunication as needed
• Maintain documentation in electronic record
• Prepare and send requested complaint and grievance packets to DBHIDS monthly
• Responsible for sending and retrieving files to/from Global for transcription and preferred language requests
• Provide a summary of providers response to any Quality of Care Concerns related to Complaints and Grievances

Position Requirements:

Education:

• Bachelors Degree
• License/Certification: N/A
• Relevant Work Experience: behavioral health experience preferred

Skills:

• Detail-oriented
• Strong organization and prioritization skills
• Computer skills including demonstrated proficiency in Excel and database maintenance
• Strong verbal and written communication skills
• Strong customer service skills

CBH offers a robust compensation and benefits package including:

• Family Planning Fertility Adoption Benefits
• 403B Retirement Plan
• PTO Days/Sick Days
• Wellness Program
• Employee Assistance Program
• Health Dental Vision Insurance
• Medical Prescription Drug Insurance
• Tuition Reimbursement
• Commuter Benefits
• Flexible Spending

Core Expectations:

Community Behavioral Health (CBH) will hold each employee accountable for the following expectations which align with our mission vision and corporate code of conduct.

• Perform key responsibilities as detailed in this job description in a dependable responsible and positive manner consistent with all state and federal guidelines.
• Serve as a role model by exemplifying professional behavior language skills and attire in order to promptly and accurately serve the needs of stakeholders members and their families.
• Assure adherence to CBH policies and procedures so that all work is of the highest quality and delivered in the most culturally competent and cost effective manner.
• Promote and manage diversity and acceptance within CBH and with all members and stakeholders by honoring and respecting their individuality dignity and rights.
• Offer suggestions and develop solutions to help promote effective and efficient work processes and innovative programs.
• Actively participate in required meetings and complete all mandatory trainings.
• Maintain high levels of advocacy and member confidentiality to ensure the success of CBH and our mission.
• Assist in assuring both internal and external program integrity by being alert to and reporting suspected instances of provider and employee fraud waste or abuse.

Philadelphia Residency Requirement:

• The successful candidate must be a current Philadelphia resident or become a resident within six months of hire.

U.S. Authorization Requirement:

• CBH does not provide sponsorship for applicants requiring future work authorization. All candidates must be legally authorized to work in the United States without requiring sponsorship now or in the future.

Equal Employment Opportunity:

• We strive to promote and sustain a culture of diversity inclusion and belonging every day. CBH is an equal opportunity employer. We do not discriminate in recruiting hiring promotion or any other personnel action based on all qualified individuals. This is without regard to race ethnicity creed color religion national origin age sex/gender marital status gender identity sexual orientation gender identity or expression disability protected veteran status genetic information or any other characteristic protected individual genetic information or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function by applicable federal state or local law.

Requesting An Accommodation:

• CBH is committed to providing equal employment opportunities for individuals with disabilities or religious observance including reasonable accommodation when needed. If you are hired by CBH and require an accommodation to perform the essential functions of your role you will be asked to participate in our accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodation once hired.
• If you would like to be considered for employment opportunities with CBH and have accommodation needs for a disability or religious observance please send us an email at