case manager (healthcare).

• rancho cucamonga , california

• posted april 5, 2024

job details

summary

• $34 - $39 per hour

• temporary

• bachelor degree

• category office and administrative support occupations

• referenceAB_4508085

job details

Our client is a leading healthcare company with an urgent need for an experienced Case Manager in Rancho Cucamonga, CA! This position will start onsite for several weeks for training, before being remote. Candidates will still need to live within a commutable distance, as this position could return to office full-time in the future. This is a one-year assignment, with potential to extend. The ideal candidates has 6+ years of healthcare customer service experience, specifically handling grievances, appeals, and escalations. The Case Manager will communicate heavily with customers/patients over the phone and in virtual meetings. Bachelor's degree highly preferred.

salary: $34 - $39 per hour

shift: First

work hours: 8:30 AM - 5 PM

education: Bachelors

Responsibilities

• Participate in managing the organization's complaint and grievance/appeals process (required)

• 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.

Skills

• Healthcare

• Certified Case Manager (CCM)

• Healthcare Network

• Healthcare Law

• Healthcare System Navigation

• Organization

• Prioritizing

• Working Independently

• Decision Making

• Answering Phones

• Oral Communication

• Handling Confidential Information

• Problem Solving

• Written Communication

• Microsoft Office

• Grievances and Appeals

• Escalations

• Conflict Resolution

• Healthplan

• Correspondence

• Healthcare Customer Service

Qualifications

• Years of experience: 0 years

• Experience level:

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Equal 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, 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 HRsupport@randstadusa.com.

Pay 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 offers a comprehensive benefits package, including health, an incentive and recognition program, and 401K contribution (all benefits are based on eligibility).

Applications accepted on ongoing basis until filled.

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.

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AC

aristotle cunanan

• aristotle.cunanan@randstadusa.com