Remote Case Coordinator

2 weeks ago

Culver City, California, United States Advanced Medical Review Full time
Overview

Remote Case Coordinator is responsible to ensure reports are of the highest quality and integrity and in full compliance with client contractual agreement, regulatory agency standards and/or federal and state mandates. This position is required to assist with quality assurance questions and provide overall support to the Quality Assurance Department. Pay for this position $19 per hour.

Responsibilities

ESSENTIAL DUTIES AND RESPONSIBILITIES TO PERFORM THIS JOB SUCCESSFULLY INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING:
  • Performs quality assurance review of reports, correspondences, addendums or supplemental reviews.
  • Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
  • Ensures that all client instructions and specifications have been followed and that all questions have been addressed.
  • Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.
  • Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
  • Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.
  • Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.
  • Ensures the provider credentials and signature are adhered to the final report.
  • Identifies any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed.
  • Assists in resolution of customer complaints and quality assurance issues as needed.
  • Ensures all federal ERISA and/or state mandates are adhered to at all times.
  • Provides insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.
  • Promote effective and efficient utilization of company resources.
  • Participate in various educational and or training activities as required.
  • Perform other duties as assigned.
Qualifications

EDUCATION AND/OR EXPERIENCE

High school diploma or equivalent required. A minimum of two years clinical or related field experience; or equivalent combination of education and experience. Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability.

QUALIFICATIONS
  • Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
  • Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages.
  • Must be a qualified typist with a minimum of 40 W.P.M
  • Must be able to operate a general computer, fax, copier, scanner, and telephone.
  • Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
  • Must possess excellent skills in English usage, grammar, punctuation and style.
  • Ability to follow instructions and respond to upper managements' directions accurately.
  • Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
  • Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
  • Must be able to work independently, prioritize work activities and use time efficiently.
  • Must be able to maintain confidentiality.
  • Must be able to demonstrate and promote a positive team -oriented environment.
  • Must be able to stay focused and concentrate under normal or heavy distractions.
  • Must be able to work well under pressure and or stressful conditions.
  • Must possess the ability to manage change, delays, or unexpected events appropriately.
  • Demonstrates reliability and abides by the company attendance policy.
  • Must maintain a professional and clean appearance at all times consistent with company standards.
Founded in 2004, AMR is setting the industry standard in providing quality independent medical case review and utilization management services that are timely, customizable and affordable. AMR offers a single source solution for all of our clients' review and utilization management needs covering all specialties and subspecialties nationwide. Our highly trained compliance staff and specialized case review nurses are bolstered by a strong quality assurance process guaranteeing the highest quality standards throughout the review process. Our commitment is to our clients and their patients. We emphasize - throughout all the work that we do - continuous quality improvement, innovation and client satisfaction.

AMR offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.

Advanced Medical Reviews is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.

Equal Opportunity Employer - Minorities/Females/Disabled/Veterans

  • RN Case Manager

    4 weeks ago

    Culver City, California, United States Prospect Medical Holdings, Inc. Full time

    The RN Case Manager is responsible for performing a high level clinical assessment and reassessment of acute care Inpatients for the purpose of performing utilization review, resource management and safe discharge planning. The RN Case Manager prioritizes, plans, organizes, and implements timeliness of care. Collaborates with the interdisciplinary healthcare...

  • RN Case Manager

    4 weeks ago

    Culver City, California, United States Prospect Medical Holdings, Inc. Full time

    The RN Case Manager is responsible for performing a high level clinical assessment and reassessment of acute care Inpatients for the purpose of performing utilization review, resource management and safe discharge planning. The RN Case Manager prioritizes, plans, organizes, and implements timeliness of care. Collaborates with the interdisciplinary healthcare...

  • Case Manager

    2 weeks ago

    Culver City, California, United States St. Joseph Center Full time

    Company DescriptionBackgroundSince 1976, St. Joseph Center has been meeting the needs of low-income and homeless individuals and families in Venice, Santa Monica, Mar Vista, and surrounding communities. The Center is a 501(c)(3) nonprofit community organization that assists people without regard for religious affiliation or lack thereof through comprehensive...

  • Case Manager

    2 weeks ago

    Culver City, California, United States Prospect Medical Holdings Full time

    The Case Manager, UR is responsible for overseeing the daily operations of the assigned caseload. Ensures Medical Necessity for patient admission and concurrent stay at the short-term acute hospital level of care are met, utilizing the facility approved non-MD reviewer guidelines. Communicates as appropriate to the payer. Refers all cases not meeting MN for...

  • Discharge Coordinator

    2 weeks ago

    Culver City, California, United States Prospect Medical Holdings Full time

    The Discharge Coordinator, under the direction of the Case Manager, coordinates post-acute patient level of care needs (SNF's, Sub Acute, LTACH, Home Health Agencies, DME, etc) to facilitate a safe discharge of hospital patients, including barrier patients, to the appropriate setting, assuring continuity of care. Notifies receiving facility of insurance...

  • Intensive Services Case Manager

    1 month ago

    Culver City, California, United States Century Housing Corporation Full time

    Intensive Services Case Manager - Case Manager, IIExciting Opportunity in Long Beach, South Bay, Orange County, CAOVERVIEW: Intensive Case Management Services (ICMS) are crucial for supporting individuals experiencing or at risk of homelessness, with complex health and behavioral health issues. The ICMS team uses a dedicated approach to help clients...

  • Intensive Services Case Manager

    4 weeks ago

    Culver City, California, United States Century Housing Corporation Full time

    Intensive Services Case Manager - Case Manager, IIExciting Opportunity in Long Beach, South Bay, Orange County, CAOVERVIEW: Intensive Case Management Services (ICMS) are crucial for supporting individuals experiencing or at risk of homelessness, with complex health and behavioral health issues. The ICMS team uses a dedicated approach to help clients...

  • Intensive Services Case Manager

    1 month ago

    Culver City, California, United States Century Housing Corporation Full time

    Intensive Services Case Manager-Case Manager, IINOW HIRING for Opportunities available in Long Beach, South Bay, Orange County, CA GENERAL SUMMARY: Intensive Case Management Services (ICMS) form the core of the services for people who are homeless, at risk of homelessness, formerly homeless and who have complex health and/or behavioral health conditions; are...

  • Intensive Services Case Manager

    4 weeks ago

    Culver City, California, United States Century Housing Corporation Full time

    Intensive Services Case Manager-Case Manager, IINOW HIRING for Opportunities available in Long Beach, South Bay, Orange County, CA GENERAL SUMMARY: Intensive Case Management Services (ICMS) form the core of the services for people who are homeless, at risk of homelessness, formerly homeless and who have complex health and/or behavioral health conditions; are...

  • Family Support Coordinator Specialist

    2 weeks ago

    Culver City, California, United States Inclusive Employment Services Full time

    Benefits/PerksFlexible ScheduleMileage ReimbursementCellphone StipendJob SummaryAs a Coordinated Family Support (CFS) Specialist at Premier Support services, you'll play a crucial role in assisting individuals and families by coordinating various services and supports that enable participants to maintain their residence within their family home. Your daily...

  • Quality & Compliance Coordinator - West Los Angeles

    2 weeks ago

    Culver City, California, United States HealthCare Talent Full time

    HealthCare Talent is now a division of Cross Country Healthcare.Bridging the gap between your dreams and your current healthcare position. Quality & Compliance Coordinator - West Los Angeles Location : Culver City, CAJob Type : DirectJob Industry : Healthcare - Health ServicesJob Description :Quality & Compliance Coordinator - Q&CC - West Los AngelesPACE...

  • Nurse Case Manager

    2 weeks ago

    Daly City, California, United States Paradigm Full time

    Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation...

  • Production Manager, Live Sports Production

    2 weeks ago

    Culver City, California, United States Amazon Services LLC Full time

    3+ years of budgeting, scheduling and cost reporting experience 3+ years of producer, production manager or line producer experience 3+ years of overseeing and managing projects and deadlines experience Indepth experience and knowledge on procurement of technical and broadcast equipment to execute event productionCome and be a part of Amazon's dynamic Live...

  • Network and Security Administrator

    2 weeks ago

    Culver City, California, United States Net2source Full time

    Net2Source is a Global Workforce Solutions Company headquartered at NJ, USA with its branch offices in Asia Pacific Region. We are one of the fastest growing IT Consulting company across the USA and we are hiring "Network and Security Administrator " for one of our clients. We offer a wide gamut of consulting solutions customized to our 450+ clients ranging...

  • Service Coordinator

    2 weeks ago

    Yuba City, California, United States Alta California Regional Center Full time

    Job Type Full-time Description THE ORGANIZATION Alta California Regional Center (ACRC) is a non-profit agency under contract to the State of California and for 50 years has provided the coordination of services to individuals with developmental disabilities. ACRC employs approximately 700+ individuals working out of eight offices in a ten-county area. ACRC...

  • Editorial & Marketing Partnerships Specialist

    1 month ago

    Culver City, California, United States Believe Full time

    The Editorial & Marketing Partnerships (E.M.P.) Specialist will coordinate and execute Believe's Trade Marketing activities for the Distribution branch and ensure the best promotion of Believe's catalogues on local digital services.Artists & Labels promotion & relationships with US Digital platforms:Maintain close relationship with key local contacts at...

  • Editorial & Marketing Partnerships Specialist

    4 weeks ago

    Culver City, California, United States Believe Full time

    The Editorial & Marketing Partnerships (E.M.P.) Specialist will coordinate and execute Believe's Trade Marketing activities for the Distribution branch and ensure the best promotion of Believe's catalogues on local digital services.Artists & Labels promotion & relationships with US Digital platforms:Maintain close relationship with key local contacts at...

  • Bilingual Clinical Case Manager

    2 weeks ago

    Redwood City, California, United States StarVista Full time

    JOB TITLE: Bilingual Clinical Case Manager DEPARTMENT: School Based Services REPORTS TO: Program Director POSITION STATUS: Full-Time-Non-exempt-40 hours per week SALARY: $24-$26 per hour DESCRIPTION: StarVista is a 501(c)(3) nonprofit organization that has helped people of all ages throughout San Mateo County navigate life challenges for over 55 years....

  • Administrative Operations Coordinator

    2 weeks ago

    Redwood City, California, United States Team Esface Basketball Academy Full time

    Job DescriptionJob DescriptionThe Peninsula's Premier Basketball Academy for Youth Basketball: Team Esface Basketball AcademyAre you a meticulous numbers wizard with a passion for sports and youth development? Do you thrive in a fast-paced environment where every day brings new challenges? If so, we have an exciting opportunity for youTeam Esface Basketball...

  • CX Product Supervisor

    4 weeks ago

    Culver City, California, United States Skims Full time

    About the jobSKIMS is a solutions-oriented brand creating the future of underwear, shapewear and loungewear. We're disrupting the industry with our game-changing product and culturally driven creative and are looking for a Customer Experience Product Supervisor to join us in building the next generation of intimates and apparel.You will be responsible for...