Roslynn Dickens

· Intake cases that are received from members and providers for appeals and grievance and gather records and missing information from the members and providers.

· Coordinate with the medical directors and outside vendors for case reviews.

· Ensure all cases are processed within mandated time frames.

· Communicate the outcome of the appeal decision to the members and providers.

· Help assist management and other departments identify trends and suggest improvement.

· Assist in special projects to help improve the department.

· Lead the state fair hearing process.

· Train new teammates on team processes and state fair hearings.

· Back the escalation process.

· Support the team with any questions on process and procedures.

· Intake cases that are received from members and providers for appeals and grievance and gather records and missing information from the members and providers.

· Coordinate with the medical directors and outside vendors for case reviews.

· Ensure all cases are processed within mandated time frames.

· Communicate the outcome of the appeal decision to the members and providers.