Overview
Case Manager (healthcare) Jobs in Rancho Cucamonga, CA at Randstad USA
Title: Case Manager (healthcare)
Company: Randstad USA
Location: Rancho Cucamonga, CA
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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