Description

Job Summary:

Oversees the daily operations of the local Member Services department responsible for responding to inquiries by health plan members. Supervises staff to ensure adherence to proper member service procedures and service level requirements in accordance to regulatory laws. Investigates causes of member inquiries and complaints.

Essential Responsibilities:

• Manages the day to day local Member Services operations including face-to-face customer interactions, complaint and grievance processing, and supervision of staff. Facilitates the effective and timely response to member inquiries, the resolution of member complaint and grievance cases. Ensures regulatory requirements and internal departmental standards are met.
• Monitors and analyzes causes of member complaints and inquiries. Monitors service levels. Oversees the work product of the staff to ensure the consistent and timely response and handling of member complaints and issues within regulatory requirements.
• Recommends, develops and participates in the implementation of action plans aimed at improving service delivery and promote member satisfaction and retention. Recommends goals, objectives, policies and performance standards.
• Educates and coaches staff and staff members in assigned local facilities regarding regulatory compliance issues. Coaches a professional staff in identifying, addressing, and resolving select member-provider and member-system conflict in order to prevent professional liability, reduce organizational risk and retain satisfied members.
• Identifies, develops and conducts training for staff members and other medical center department members regarding regulatory changes based on a review and analysis of customer contact data and audit trends.
• Represents the organization to external clients, including regulatory agencies, employer groups, and potential customers in the resolution of high-profile cases in support of maintaining business partnerships.
• Serves as a resource in areas that require customer service expertise. Advises and coaches Medical Center administrative staff members with issues regarding customer service strategies.
• Interviews and recommends candidates for employment and termination.
• Conducts performance evaluations and salary reviews for assigned staff.

Basic Qualifications:

Experience

• Minimum three (3) years of experience in a position requiring extensive, complex problem solving and high-level negotiations involving compliance with regulatory requirements.
• Minimum two (2) years of supervisory or team lead experience.

Education

• Bachelor degree in business administration, operations research, public health administration, or other related field OR four (4) years of experience in a directly related field.
• High School Diploma or General Education Development (GED) required.

License, Certification, Registration

• N/A

Additional Requirements:

• Demonstrated knowledge of federal and state regulations, laws and accreditation standards related to health care and managed care organizations.
• Working knowledge of audit techniques, concets and standards including inter-rater reliability.
• Proven skills in conflict resolution and mediation with ability to handle sensitive issues independently and escalate when necessary.
• Effective interpersonal as well as verbal and written communication skills.
• Demonstrated ability in managing a high-profile and/or large, diverse case load of complex issues preferred.
• Demonstrated ability in performing thorough investigations, developing logical conclusions and effective analytical reports.
• Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications:

• Experience working with accreditation and regulatory agencies preferred, such as Dept. of Health Services (DHS), Dept. of Corporations (DOC), Health Care Financing Administration (HCFA), National Committee for Quality Assurance (NCQA), and state programs.
• Previous experience in supervision and/or experience in training techniques preferred.Experience in preparing and conducting audits preferred.

Notes:

• This is a temporary position.

Primary Location: California,Harbor City,South Bay Medical Center
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri
Working Hours Start: 08:00 AM
Working Hours End: 05:00 PM
Job Schedule: Full-time
Job Type: Standard Worker Location: Onsite
Employee Status: Temporary
Employee Group/Union Affiliation: NUE-SCAL-01|NUE|Non Union Employee
Job Level: Manager with Direct Reports
Department: Regional Offices - Pasadena - Mbr Svc-Member Relations - 0808
Pay Range: $80600 - $104280 / year Kaiser Permanente is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills and geographic location along with a review of current employees in similar roles to ensure that pay equity is achieved and maintained across Kaiser Permanente. Travel: Yes, 20 % of the Time On-site: Work location is on-site (KP designated office, medical office building or hospital). Worker location must align with Kaiser Permanente's Authorized States policy. Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.

For jobs where work will be performed in unincorporated LA County, the employer provides the following statement in accordance with the Los Angeles County Fair Chance Ordinance. Criminal history may have a direct, adverse, and negative relationship on the following job duties, potentially resulting in the withdrawal of the conditional offer of employment:

Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente's Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state, and local laws and regulations, accreditation, and licensure requirements (where applicable), and Kaiser Permanente's policies and procedures.

Models and reinforces ethical behavior in self and others in accordance with the Principles of Responsibility, adheres to organizational policies and guidelines; supports compliance initiatives; maintains confidences; admits mistakes; conducts business with honesty, shows consistency in words and actions; follows through on commitments.

Job duties with at least occasional or possible access to: (1) patients, the general public, or other employees; (2) confidential protected health information and other confidential KP information (including employee, proprietary, financial or trade secret information); (3) KP property and assets, for example, electronic assets, medical instruments, or devices; (4) controlled substances regulated by federal law or potentially subject to diversion.

Requisition #: 1381621

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