The Role
Manage participant and caregiver grievances per state and federal regulations, collaborate with leadership on quality improvement, educate stakeholders on grievance processes, analyze trends, assist with corrective action plans and survey readiness, conduct annual satisfaction surveys, and support EHR-related documentation.
Summary Generated by Built In
POSITION SUMMARY: The Participant Satisfaction Coordinator is responsible for addressing participant and caregiver grievances as required by State and Federal regulations. This person is solution oriented and collaborates with department leaders to provide creative, thoughtful, participant centered resolutions. The Participant Satisfaction Coordinator’s responsibility is to increase participant/caregiver satisfaction with Rocky Mountain Health Care Services while maintaining the highest quality of care for the individuals being served by our program.
MISSION: Improving lives, Optimizing wellness, Promoting independence.
COMPETENCIES:
- Technical Expertise
- Problem Solving
- Teamwork
- Effective Communication
- Results Oriented
- Stress Management
- Personal Credibility
- Quality Focus
- People Focus
- Flexibility
RESPONSIBILITIES AND DUTIES:
ESSENTIAL JOB FUNCTIONS:
- Supporting a culture of quality and compliance within Rocky Mountain Health Care Services.
- Having a professional and cooperative working relationships with RMHCS leadership and RMHCS Quality and Compliance department.
- Demonstrates critical thinking and problem solving on a consistent basis.
- Manages grievances using a participant centered approach.
- Adheres to all State and Federal regulations as it pertains to grievances and quality improvement.
- Provides education on the grievance process to participants, caregivers, contracted partners and RMHCS associates.
- In collaboration with the RMHCS Leadership, reviews trends, identifies cause of any adverse trends and implements quality improvement activities as appropriate.
- Utilizes appropriate tools/methodologies to effectively measure project outcomes.
- Assists with completion, submission and follow up of Corrective Action Plans.
- Assists with Federal and State survey readiness.
- Responsible for having a strong working knowledge of the current electronic health record.
- Is a member of the RMHCS Quality Improvement Committee.
- Participates in the Participant Advisory Committee.
- Facilitates the Caregiver Advisory Committee.
- Conducts the Participant/Caregiver Satisfaction Survey annually.
- Other duties as assigned.
Education:
- Minimum: High school diploma or equivalent with 2+ years of health care experience related to the grievance process or quality assurance programs.
- Preferred: Bachelor’s degree in Social Work, Nursing, Gerontology, or a related field.
Experience:
- 2+ years of experience in healthcare, long-term care, or social services.
- Prior experience with grievance, appeals, or compliance processes.
- Familiarity with CMS regulations and state guidelines for PACE or other managed care programs.
- Experience working with older adults and/or individuals with complex medical and social needs.
Skills and Knowledge:
- Understanding of grievance and appeals processes under federal and state regulations, especially those pertaining to PACE.
- Knowledge of participants’ rights and responsibilities under Medicare/Medicaid.
- Excellent communication skills — able to speak with empathy, clarity, and professionalism.
- Strong documentation and report-writing skills.
- Ability to analyze patterns or trends in grievances and recommend systemic improvements.
- Proficiency in Microsoft Office and electronic health record (EHR) systems.
Other Attributes:
- Strong interpersonal skills and cultural sensitivity.
- Ability to maintain confidentiality and handle sensitive information.
- Problem-solving mindset with a focus on participant-centered care.
- Team-oriented but capable of working independently.
We strive to provide our employees with a comprehensive and affordable benefits package including Medical and Prescription Drug, Dental, Vision Care, Wellness Program, Telemedicine Program, Flexible Spending Accounts, Health Savings Account, Company Paid Basic Life and Accidental Death & Dismemberment, Company Paid Long-Term Disability, Voluntary Life Insurance, Voluntary Short-Term Disability, Accidental Injury Insurance, Critical Illness, Hospital Indemnity, 403(b) Savings Plan, Legal Shield and IDShield, Employee Assistance Program (EAP), Paid Time-Off plan. Such benefits are based on applicable state law and factors such as pay classification (full-time,part-time,or PRN/casual), job grade and length of service.
Skills Required
- High school diploma or equivalent with 2+ years of healthcare experience related to grievance or quality assurance programs
- Bachelor's degree in Social Work, Nursing, Gerontology, or related field
- 2+ years of experience in healthcare, long-term care, or social services
- Prior experience with grievance, appeals, or compliance processes
- Familiarity with CMS regulations and state guidelines for PACE or other managed care programs
- Experience working with older adults and/or individuals with complex medical and social needs
- Understanding of grievance and appeals processes under federal and state regulations
- Knowledge of participants' rights and responsibilities under Medicare/Medicaid
- Excellent communication skills with empathy, clarity, and professionalism
- Strong documentation and report-writing skills
- Ability to analyze patterns or trends in grievances and recommend systemic improvements
- Proficiency in Microsoft Office and electronic health record (EHR) systems
- Ability to maintain confidentiality and handle sensitive information
- Team-oriented but capable of working independently
Am I A Good Fit?
Get Personalized Job Insights.
Our AI-powered fit analysis compares your resume with a job listing so you know if your skills & experience align.
Success! Refresh the page to see how your skills align with this role.
The Company
What We Do
Bethesda Group, LLC is a boutique consulting group focused on helping small and mid-stage diagnostic companies and investment groups move emerging diagnostic content and platforms into the marketplace. Their extensive experience includes C-Suite leadership in large and startup companies, raising over $100M in funding, successfully implementing Sarbanes Oxley, and delivering over 60 LDT applications and 15 FDA-cleared instrument systems to the market.
