Member Rights Specialist I

Community Care is hiring a Member Rights Specialist. This rewarding opportunity is perfect for someone who enjoys coordinating and facilitating resolutions of grievances, appeals and working for a non-profit, mission driven organization. This is a full-time opportunity at our Bishops Woods location. $2,000 Sign On Bonus 

Member Rights Specialist Job Responsibilities:

• Coordinates and facilitates resolution of member grievances and appeals 

• Coordinates flow of documents and communication between departments, interfaces with internal and external resources, and responds to inquiries for information or documentation from parties involved in grievances or appeals. 
• Researches, evaluates, responds and closes grievances and appeals.
• Supports members and legal decision makers in understanding their rights related to Medicare/Medicaid services.
• Raises awareness of member rights role within and outside of the organization, including attending external advocacy meetings and interacting with the community and advocacy organizations.
• Maintains knowledge of grievance/appeal reporting requirements for the Office of the Center of Medicare/Medicaid Services, DHS, and Metastar.
• Prepares narratives, graphs and analysis used for presentations, audits and external reporting.
• Participates in state and federal quality and compliance reviews.
• Supports the organizations' quality function through operational activities such as internal file reviews or other audits as assigned. 
• Supports formal and informal performance improvement initiatives as assigned.
• Performs other job-related duties as assigned.

This position interfaces with the Department of Health Services (DHS), the Division of Hearings and Appeals (DHA), Ombudsman Program, the
State’s External Review organization (MetaStar) and federal agencies as required.


Member Right Specialist Required Experience:

A minimum of three years of previous experience working with persons to promote their rights and resolve concerns required. Demonstrated ability to develop sound, effective plans aligned with meeting members’ needs. Leadership experience and previous involvement in quality improvement projects preferred.

Member Right Specialist Education

Associate Degree in healthcare or social service field required.

Bachelor's degree in healthcare or social service field preferred

Member Right Specialist Hours:

Monday - Friday 8:00AM - 4:30PM

Travel: Regular local travel, requiring use of personal vehicle, valid driver's license, and proof of required insurance coverage.

About Community Care Community Care is a local nonprofit with more than 40 years of experience helping older adults and adults with disabilities live as independently as possible within the community. We coordinate and deliver a full range of supportive services that help more than 13,000 Wisconsin residents live safely, confidently, and with dignity. We are Wisconsin-based with local offices supporting each of the 15 counties we serve. Our dedicated team works with members to develop care plans to meet their health and social needs. Together with our community partners, we’re committed to providing compassionate, personalized care that empowers members to live a healthy and independent lifestyle.

Compensation and Benefits: Our employees make a real difference in people’s lives every day that is why we are proud to offer a compensation package that includes:

• Attractive full and part time schedules
• Generous paid time off
• Competitive pay and benefits (health, dental, vision, etc.)
• Retirement Plan with employer contribution
• Flexible benefits plan
• Employee referral program
• Co-Workers care program
• Employee Assistance Program

Community Care is an Equal Opportunity Employer