JOB REQUIREMENTS: Putting People First in Pharmacy- Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other. We are unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming. The Navitus Grievance and Appeals process is an essential function to Navitus\' compliance with CMS regulations, accrediting body standards, other applicable regulatory requirements, and member expectations. The Navitus Grievance and Appeals department serves as the central repository for all complaints received by Navitus and all appeal requests where the responsibility has been delegated to Navitus. The Navitus Grievance & Appeals Coordinator serves to administrate the Navitus Grievance and Appeals processes as outlined by Client/Plan Sponsors, departmental policies and procedures, and regulatory standards. Coordinator, Grievance and Appeals serves as a liaison for Navitus members, prescribers and pharmacies regarding complaints or appeals related to denied pharmacy claims, membership and benefit issues, reimbursements and quality of care or service. Coordinator, Grievance and Appeals is responsible for presentation of the member appeals as required to the Medical Director, Center for Medicare/Medicaid Services, contracted reviewer, Client, and/or the contracted external review agency in accordance with applicable laws, organization policies, and regulatory requirements. Thorough research, documentation, and corrective action planning must be established for each respective case and effectuation completed in accordance with existing regulations, policies, and standards. Is this you? Find out more below! How do I make an impact on my team? Administrate Standard and Expedited Appeals Processes as outlined in Client/Plan Sponsor Member Handbook and in compliance with applicable accrediting body standards, CMS and other state or federal regulatory requirements. Strict adherence to turn-around time and quality of documentation standards established in accordance with regulatory standards is required. Act as the primary investigator and contact person for member, prescriber or pharmacy grievances and appeals, which includes sending the appropriate acknowledgement of the grievance/appeal per policy, educating the member and/or member representative about the grievance/appeal, gathering all pertinent and relevant information... For full info follow application link. Navitus Health Solutions is an Equal Opportunity Employer: Disabled/Veterans/Male/Female/Minority/Other ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/FDC00951501443C3