Principal Grievance Nurse
CurrentLeader for provider inquiry and member response regarding member grievances for a 5 star health plan. Steward for standard of care variance data for all member grievances regarding quality of care. Department wide troubleshooting for grievance investigation with obstacles. Outreach escalation to providers with communication not meeting requested timeframe. Quality monitoring for Customer Service documentation. Education to Customer Service new hires on documentation standard. Leader for processing cost share diputes including unmet treatment standard. Preliminary investigation into member grievances regarding fraud waste and abuse. Interdepartmental communications liason.