Employee Login
0 Results

Grievances & Appeals Specialist

San Francisco, CA 94109

Posted: 06/26/2025 Industry: Administration Job Number: 52945

Job Description

Our client is looking for a Grievances & Appeals Specialist for a contract scenario.  The Grievances & Appeals Specialist plays a critical role in supporting patients and families by investigating complaints, concerns, and feedback received by the organization. The responsibilities include:

DUTIES:
  • Investigating patient/family complaints related to care quality, physician/provider actions, Company policies, and potential liability.
  • Handling highly complex and conflict-heavy cases, requiring innovation and collaboration across departments.
  • Working closely with managers, physicians, and staff to resolve patient grievances.
  • Coordinating with Legal and Risk Management on medical-legal matters.
  • Providing crisis intervention and mediation for complex institutional concerns.
  • Conducting case investigations, including interviews with patients/families, medical record reviews, and policy/procedure evaluations.
  • Facilitating case conferences and working with leadership to implement corrective action plans for quality improvement.
  • Ensuring compliance with CMS Conditions of Participation and Company grievance policies.
  • Maintaining a patient and family-centered approach, prioritizing transparency and resolution at the most appropriate levels.
  • Managing a high caseload and ensuring timely documentation to meet regulatory timelines.

REQUIREMENTS:
  • Minimum 2 years of recent relevant experience in grievances, appeals, or patient advocacy.
  • Strong oral and written communication for composing patient responses and synthesizing investigation findings.
  • Analytical skills for medical record reviews, quality-of-care investigations, and patient safety concerns.
  • Case management expertise, handling high volumes while ensuring timely compliance.
  • Conflict resolution and problem-solving in a high-stakes, fast-paced healthcare environment.
  • Technical proficiency in word processing, email, database management, and patient care software.
  • Cultural competence and ability to navigate sensitive diversity-related concerns.
  • Autonomy and resourcefulness in handling complex grievance cases.
Kavaliro provides Equal Employment Opportunities to all employees and applicants. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. Kavaliro is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Kavaliro will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please respond to this posting to connect with a company representative.
 
By using best practices and optimal employee recruiting strategies, Kavaliro provides employers with employment solutions by providing the most qualified and professional employees, who can staff both project and permanent positions in order to ensure the ongoing success of all types of businesses. We use a streamlined-yet-thorough approach to staffing that saves our clients administrative time, resources and money.
Apply Online
Apply with LinkedIn Apply with Facebook Apply with X

Send an email reminder to:

Share This Job:

Related Jobs:

Login to save this search and get notified of similar positions.

About San Francisco, CA

Ready to take your career to new heights? Explore job opportunities around the bustling city of San Francisco, California. Known for its vibrant tech scene, picturesque views of the Golden Gate Bridge, diverse culinary offerings like the famous clam chowder in sourdough bread bowls at Fisherman's Wharf, and the artistic vibe of the iconic street art at Clarion Alley. Work-life balance flourishes with easy access to outdoor adventures like hiking in Muir Woods, catching a Giants game at Oracle Park, or browsing through the exhibits at the San Francisco Museum of Modern Art. Join us in San Francisco and discover the endless possibilities this innovative and charming city has to offer.

What to expect when working with Kavaliro

Just like with our clients, we build our process to meet each individual candidate s needs. Our recruiters take the time to listen to your career goals and ambitions, then work one-on-one with you to help place you in a company that provides the best professional fit.

01

Call us with a detailed overview of your experience, skills, background, and goals. If you are local and prefer, we will set up a face-to-face interview.

02

You will be asked to complete an online assessment form to assess your skill level. At the same time, your references will be checked.

03

Your Kavaliro recruiter will discuss and review potential job opportunities.

04

When you and your recruiter agree on a potential match, you ll be briefed with helpful insight into the client s needs.

05

When you begin your employment tenure with the client, Kavaliro will continue to be there to support you in your career.

More From Kavaliro

About Us

We ve been in the staffing business for over 10 years because we receive great satisfaction helping both companies and job candidates find their perfect match.

Meet our team

Life at Kavaliro

We take culture seriously and believe true strength comes from a collaborative and open-minded environment where everyone is supported and empowered to succeed.

Learn more

Careers at Kavaliro

If you want to always have your finger on the pulse of the latest and newest trends in staffing and recruiting, join the Kavaliro team!

See internal opportunities

Career Advice

We offer guidance on resume revisions, clarifying your career objectives, and other advice to help you land your dream job.

Visit our blog