Position Requirements: Education: Master’s Degree in behavioral health, healthcare or social sciences License/Certification (if applicable): N/A Relevant Work Experience: Minimum of 2 years of experience in a managed care or quality management setting Skills: Proficient in Microsoft office applications Excellent written and verbal communication skills Knowledge of PA Act 146, Appendix H and medical necessity criteria Excellent customer service skills Excellent training & facilitating skills Strong interpersonal skills Thorough knowledge of DBH and DHS systems and services Work Conditions (including travel, overtime required, physical requirements and occupational exposure): Regularly requires walking, standing, stooping, bending, sitting, reaching, pushing, pulling and/or repetitive wrist/hand movements for various lengths of time throughout the day. Essential Functions: Review, document and process all levels of complaints and grievances Complete packet for and participate in Fair Hearing Review and address Quality Concerns stemming from complaints and grievances to determine level of follow up required (i.e., investigating or tracking).