|Reference # :||20-37361||Title :||Case Manager|
|Location :||Rancho Cucamonga, CA|
|Experience Level :||Start Date / End Date :||12/01/2020 / 11/30/2021|
|Do something big and innovative! Stretch your creative muscles and work on big issues. Since 1989, we have developed technology environments, applications, and tools by providing experienced teams to implement, enhance, and maintain our clients’ essential systems and applications. Come join the Artech team! |
Job Title: Case Manager (Local Candidates only: Position is remote due to COVID for now.)
Location: Pleasanton, CA
Duration: 12 Months
Top Daily Responsibilities:
• Research and respond to member grievances and appeals
• Meet regulatory requirements
• Improve Member Experience
Top (3) Required Skills Candidate Should Have:
• Background in grievance and appeals case processing.
• Strong organizational and time management skills
• Ability to multi-task in a fast-paced environment
Additional Skills Preferred
• Strong knowledge of federal & state regulations and Medicare/Medi-Caid regulations.
• Ability to compose high quality, detailed written communication.
• Excellent interpersonal, verbal and written communication skills.
Parking on site
Business Casual work environment
Additional Job Description:
Responsible for handling the review process for grievances, appeals, or denials including investigating, preparing and presenting appropriate materials for review. Resolves member concerns in partnership with internal and external departments while ensuring compliance with regulatory rules and timeframes, within mandated timeframes and compliance.
• Participates in handling the grievances, appeals/ denials process. Ensures appeals are processed in accordance with regulations, compliance standards and policies and procedures. Meets timeframes for performance while balancing the need to produce high quality work related to complex and sensitive member issues.
• Investigates all issues, including collection of appropriate data, preparation and presentation of documents to decision makers. Informs members or their authorized representatives, physicians and other stakeholders of Health Plan's determinations.
• Collaborates with internal staff, other MS Departments, managers and physicians to seek resolution on issues and cases affecting member while ensuring compliance, documentation and enhancing members' experience. Ensures integrity of departmental database by thorough, timely and accurate entry.
• Mentors others in preparation for positions of increased responsibility. Participates in departmental meetings, trainings and audits as requested. Answer questions and manages members on existing / open cases.
• Client’s conducts compensation reviews of positions on a routine basis. At any time, Client’s reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees.
Recruiter Name: Smita Singh
Contact Email/ Phone: email@example.com
- Life Insurance
- Flexible Spending Accounts
- Employee Referral Program
- Long Term Disability
- Employee Events
- Medical, Dental and Vision