Member Relations Consultant - 6 month contract - (Oakland, CA)

Member Relations Consultant MUST BE FLEXIBLE WITH OT AND WEEKEND WORK - Rotating weekends (every 4-6 weeks; applies to Monday - Friday shift) and holidays. Monday - Friday 8:30 am - 5 pm Tuesday - Saturday 9:30 am - 6pm Description: Manages the resolution of expedited appeals, Part D coverage determinations and redeterminations, as well as complex grievance cases. Prepares all cases in accordance with regulations, compliance standards, and policies and procedures. Investigates all complaints, grievances and appeals, including collection of appropriate documentation. Represents Health Plan in Administrative Law Judge cases. Participates in departmental meetings, trainings, and unit self-audits as requested. Participates in the expedited rounds with Nurse Case Managers and Medical Director (ERU), Part D coverage decisions and complex case unit's weekly rounds and partners with clinical consultants. Participates in benefit decisions.