QM Member Liaison Sr (US)

Job Description

QM Member Liaison Sr.

Location : The territory for this position is East TN. This position will work a hybrid model (remote and office). Therefore the selected candidate must reside within 50 miles of the Knoxville, TN PulsePoint location.

The QM Member Liaison Sr. is responsible for developing, coordinating, and implementing member advocacy initiatives within the health plan as well as member retention by investigating and leading the resolution of member complaints.

Coordinates the member advocacy program throughout the functional areas of the health plan.

How you will make an impact :

• Investigates, resolves, and documents member complaints in accordance with policies and state requirements.
• Implements comprehensive Member Advocacy Program to meet the needs members.
• Investigates and resolves issues regarding members with non-compliant, behavioral, or abusive conduct with providers.
• Identifies and submits updates upon receipt of any regulatory updates or changes.
• Collaborates with local consumer advocacy groups to gain insight regarding the special health care needs of Medicaid enrollees.
• Tracks, trends, and reports quality and access complaints; coordinates and documents follow-up actions.
• Serves as a liaison with state hot line staff and internal compliance personnel.
• Minimum Requirement : Requires a BA / BS degree in HealthCare or related field and a minimum of 5 years of experience in a social or health related service-oriented industry;

or any combination of education and experience which would provide an equivalent background.

Job Level :

Non-Management Exempt

Workshift :

1st Shift (United States of America)

Job Family : CUS >

CUS >

Service Operations

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health.

Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates.

Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week.

Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient / member-facing roles to become vaccinated against COVID-19.

If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

Applicants who require accommodation to participate in the job application process may contact for assistance.