case manager.
pleasanton , california
posted 1 day ago
job detailssummary
$30 - $31.51 per hour
contract
high school
category computer and mathematical occupations
reference1057318
job detailsjob summary:We have a 1 year contract opportunity for a Case Manager in Pleasanton, CA. This position will work from home after initial training onsite.Job Requirements:3 year of customer service background required. This is not a call center or data entry. Will need to write summaries, conduct investigations, and write 20-30 letters a week to members. Excellent grammar and writing experience is required. Must be able to both communicate and handle difficult members while showing empathy and matching the right tone. Will also need to discuss concerns and requests with physicians and hospital staff regarding patient concerns.Qualifications:Ability to use sound judgment and to handle sensitive correspondence independently but with the knowledge and ability to escalate to the appropriate person / ask for help when needed. Ability to multitask and manage time in order to perform well on high volume case load while being flexible enough to assimilate on small projects on an ongoing basis., Demonstrated ability to work in a time-sensitive, high production environment., Excellent interpersonal, verbal and written communication skills. Ability to work with peers in self-managed teams to meet deadlines.Preferred Qualifications: Knowledge of member grievance and appeals process preferred., Knowledge of federal and state laws and regulations and accreditation standards related to health care and managed care organizations.Healthcare background preferredlocation: Pleasanton, Californiajob type: Contractsalary: $30.00 - 31.51 per hourwork hours: 8am to 5pmeducation: High Schoolresponsibilities:
Participate in managing the organization's complaint and grievance process.
Accountable for investigation of all issues, including collection and documentation of appropriate data.
Identify and address specialty / flagged cases and follow appropriate processes for different types of cases
Communicate with a diverse set of internal and external clientele to achieve excellent results in the areas of complaint and grievance handling, compliance, documentation and enhancement of the member experience.
Partner with and outreach to internal staff, other MS Departments, managers and physicians to resolve issues as quickly as possible.
Research, resolve and communicate complaints and grievances filed by members and communicate Health Plan's decisions appropriately back to member or their authorized representatives
Ensure that complaints and grievances are processed in accordance with regulations, compliance standards and policies and procedures.
Meet timeframes for performance while balancing the need to produce high quality work related to complex and sensitive member issues.
Ensure integrity of departmental database by thorough, timely and accurate entry, consistent with regulatory protocols and effectively manage case resolution inbox everyday
Participate in departmental meetings, trainings and audits as requested.
Answer questions and manage members on existing / open cases
Escalate issues to management as appropriate to maintain compliance.
qualifications:
Experience level: Experienced
Minimum 3 years of experience
Education: High School
skills:
ManagerEqual Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.At Randstad Digital, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact [email protected] offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad Digital offers a comprehensive benefits package, including health, an incentive and recognition program, and 401K contribution (all benefits are based on eligibility).This posting is open for thirty (30) days.Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.