Grievance and Appeals Coordinator

Full Time Grievance and Appeals Coordinator

South Country Health Alliance

South Country Health Alliance is seeking a Grievance and Appeals Coordinator to join our team! This role is responsible for the management of his/her assigned caseload involving member complaints received at South Country Health Alliance (South Country), which may include member grievances or appeals. This person will perform advanced and complicated case review duties requiring clinical judgment, independent analysis, and detailed knowledge of departmental and regulatory procedures.

• An active Minnesota RN License and broad based clinical background;
• 3-5 + years Health plan experience and/or experience conducting complaint investigations;
• Proficiency in Microsoft Office, especially Word and Excel;
• Knowledge of federal and state regulatory requirements for appeals and grievances;
• Knowledge of MN Medicare and Medicaid
• A B.A. or B.S in Nursing is preferred

South Country Health Alliance is more than a health plan—we’re a mission‑driven organization dedicated to improving health and well‑being in rural Minnesota communities. Our work is guided by values of communication, collaboration, stewardship, and excellence, ensuring that every employee contributes to making a real difference in people’s lives.
mnscha.org

Join us and be part of an organization that values community impact, employee well‑being, and innovation.

South Country offers a wide variety of benefits including medical, dental, vision, health savings account contributions, PERA Pension, paid holidays, paid vacation, paid sick time, and more.

This position is a hybrid position—requiring in‑office time in Medford, MN as organizationally necessary. Remote status will be dependent on experience, education, skill level, and needs of the organization.

Salary for this position starts at $37.14-$45.43/hour, based on qualifications and experience.

Must be legally authorized to work in the U.S. (No sponsorship available)

The Grievance and Appeals Coordinator is responsible for the management of his/her assigned caseload involving member complaints received at South Country Health Alliance (SCHA), which may include member grievances or appeals. This person will perform advanced and complicated case review duties requiring clinical judgment, independent analysis, and detailed knowledge of departmental and regulatory procedures.

Required: RN with an active license in the State of MN and a broad‑based clinical background; 3-5 years health care experience;
Knowledge of federal and state regulatory requirements for appeals and grievances;
Proficient in Microsoft Office, especially Word and Excel.

Preferred: B.A. or B.S. in Nursing;
Health plan experience and/or experience conducting investigations or processing appeals. Skill Sets:
Ability to work independently;
Critical thinking skills;
Investigative and creative problem‑solving skills;
Excellent written and verbal communication skills;
Ability to work cross‑departmentally and effectively with business partners including Third Party Administrators (TPAs), health care providers and professionals;
Organizational and time management skills.