Complaints Quality Specialist

At Lucet, we are industry leaders in behavioral health, dedicated to helping people live healthy, balanced lives. Our purpose is to advocate for and improve the overall well-being of those we serve, through balanced treatment of the mind and body. When you join Lucet, you become a valued member of our team, serving more than 15 million people across the U.S. Our employees have a passion for helping others - and it shows. From entry-level employees to senior leaders, we are inspired by our members, putting them first in everything we do. From day one, you'll see firsthand the impact you have on our members, knowing you can make a true difference in their lives. Why join our team at Lucet? We are a team of collaborative and hard-working professionals working to improve behavioral health outcomes working in a fast-paced and changing environment. At Lucet, no two days are the same. If you find joy in meaningful work and delivering excellent results, we encourage you to apply! We are looking for top-tier skills and experience in our remote-work environment and that’s because we offer top-tier compensation and benefits, which include: The starting salary that Lucet reasonably expects to pay for this position ranges from $69,000 - $80,000 annually, PLUS an annual performance-based, discretionary . Compensation is dependent on non-discriminatory factors including but not limited to an applicant's skills, education/degrees, certifications, prior experience, market data, and other relevant factors. Full Health Benefits – Medical, Dental, and Vision 401(k) with competitive employer match Company paid life and disability insurance, wellbeing incentives, and parental leave Professional development opportunities and tuition reimbursement Paid time off including paid time off for volunteering Opportunity for meaningful growth, both personally and professionally, where your unique background and experience is welcomed and valued.

The Complaints Quality Specialist is responsible for the processing of quality of care complaints, grievances and incidents. Duties include all aspects of clinical quality of care complaint and incident investigations including documentation, interviews, obtaining responses from providers or facilities, reviewing medical records, staffing findings with the medical director, and resolution processes. This position requires knowledge of standards of care, identification of trends and include audit activity of medical records.

Complaint and Incident Documentation - Appropriate processing and documentation of complaints, grievances, and incidents. Professional Investigation and Resolution - Manage complaint investigations and resolution processes professionally, confidentially, collaboratively and timely. Clinical and Regulatory Review - Review patient medical records and utilize clinical and regulatory knowledge and skills to investigate complaints, grievances, and incidents. Data Collection and Statistical Analysis - Perform data collection and analyses used for complaints and incident reports and audits; departmental and improvement teams; and accreditation. Use statistical analyses as appropriate.