CVS Health SMI Grievance Investigator in Phoenix, Arizona
Independently investigate behavioral health human rights violations ensuring compliance with Federal and/or State regulations and the Arizona Administrative Code. Responsible for compliance with policies of all applicable Federal and/or State government agencies, including but not limited to Center for Medicare and Medicaid Services (CMS) as well as the Arizona Health Care Cost Containment System (AHCCCS).
Independently researches and translates organizational policy into intelligent and logically written investigation reports and decision letters.
Manages timelines to ensure state guidelines are met and investigations are timely.
May create and communicate grievance policies, procedures, and outcomes with all levels of the organization.
Successfully works across functions, teams, providers, and community agencies on investigations to resolve escalated cases.
Demonstrates strong letter writing skills; drafts individual letters based on current findings, regulations and legislation.
Minimum of 2-3 years of experience in a behavioral health setting such as Case Management, behavioral health hospital setting, residential treatment or group home.
Good knowledge of AHCCCS, Seriously Mentally Ill (SMI), and healthcare industry.
Excellent organizational skills
Preferred bachelor’s degree desired or equivalent work experience.
High School Diploma, some college necessary.
Additional Job Information
Independently and accurately able to multi-task projects; ability to be self-sufficient while researching, performing analysis and applying resources necessary to complete a final assessment of the required and appropriate action (verbal and/or written)Negotiation skillsStrong analytical skillsAttention to detailAutonomously makes decisions based upon current policies/guidelinesActs decisively to ensure business continuity and with awareness of all possible implications and impactExpert knowledge of clinical terminology, regulatory and accreditation requirements
Bachelor's degree or equivalent experience
Percent of Travel Required
0 - 10%
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.