case manager

4 weeks ago

Rancho Cucamonga, United States Randstad Full time

case manager.

  • rancho cucamonga , california

  • posted 2 days ago

job details

summary

  • $39.45 - $40.54 per hour

  • contract

  • high school

  • category computer and mathematical occupations

  • reference1053663

job details

job summary:

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.

  • How many years of related experience are you looking for in your ideal candidate? 6 years customer service. Heavy writing and speaking with customers over the phone. Microsoft excel, word, really help. Healthcare environment is a plus.

  • Research and respond to member grievances and appeals that pose a risk to the organization in short timeframes 24 hours to 72 hours.

  • Meet regulatory requirements

  • Improve Member Experience

  • Extensive organization skills

  • Excellent verbal and written communication skills

  • Time Management

location: Rancho Cucamonga, California

job type: Contract

salary: $39.45 - 40.54 per hour

work hours: 8am to 4pm

education: High School

responsibilities:

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.

  • Required Level of Education and Preferred Level of Education: HS Diploma but Bachelors is preferred

  • How many years of related experience are you looking for in your ideal candidate? 6 years customer service. Heavy writing and speaking with customers over the phone. Microsoft excel, word, really help. Healthcare environment is a plus. Blueshield, Aetna, Healthcare providers (this is a huge plus)

  • Research and respond to member grievances and appeals that pos a risk to the organization in short timeframes 24 hours to 72 hours.

  • Meet regulatory requirements

  • Improve Member Experience

  • Extensive organization skills

  • Excellent verbal and written communication skills

  • Time Management

qualifications:

  • Experience level: Experienced

  • Minimum 3 years of experience

  • Education: High School (required)

skills:

  • Customer RelationsEqual 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 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 Digital 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.

  • Case Manager

    3 weeks ago

    Rancho Cucamonga, United States Hannah's Children's Homes Full time

    Job DescriptionJob DescriptionWe are looking for a Case Manager to join our team! The case manager will be responsible for assigning, monitoring, and organizing cases for social work. They will be directly involved in the lives of their clients, and provide resources and assistance. Planning health services, working with social workers and doctors, and...

  • Case Manager

    3 weeks ago

    Rancho Cucamonga, United States Artech Full time

    Major Responsibilities/Essential Functions: 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...

  • ORR Case Manager

    2 months ago

    Rancho Cucamonga, United States Hannah's Children's Homes Full time

    Job DescriptionJob DescriptionWe are looking for a Case Manager to join our team! The case manager will be responsible for assigning, monitoring, and organizing cases for social work. They will be directly involved in the lives of their clients, and provide resources and assistance. Planning health services, working with social workers and doctors, and...

  • Case Manager

    1 month ago

    Rancho Cucamonga, United States SIMPLE SOLUTIONS PSYCHOTHERAPY Full time

    Job DescriptionJob DescriptionJob Description: Our Case Manager manages caseloads for clients and is responsible for coordinating and managing healthcare and wellness services and resources for clients. This role involves liaising with healthcare providers, clients, and other members of their care circle to ensure proper care and treatment plans are in...

  • Case Manager

    3 weeks ago

    Rancho Cucamonga, United States SIMPLE SOLUTIONS PSYCHOTHERAPY Full time

    Job DescriptionJob DescriptionJob Description: Our Case Manager manages caseloads for clients and is responsible for coordinating and managing healthcare and wellness services and resources for clients. This role involves liaising with healthcare providers, clients, and other members of their care circle to ensure proper care and treatment plans are in...

  • Case Manager

    3 weeks ago

    Rancho Cucamonga, United States SIMPLE SOLUTIONS PSYCHOTHERAPY Full time

    **Benefits**: - 401(k) matching - Dental insurance - Flexible schedule - Free food & snacks - Health insurance - Paid time off Job Description: Our Case Manager manages caseloads for clients and is responsible for coordinating and managing healthcare and wellness services and resources for clients. This role involves liaising with healthcare providers,...

  • Case Manager

    4 weeks ago

    Rancho Cucamonga, United States SIMPLE SOLUTIONS PSYCHOTHERAPY Full time

    Job DescriptionJob DescriptionBenefits:401(k) matchingDental insuranceFlexible scheduleFree food & snacksHealth insurancePaid time off Job Description: Our Case Manager manages caseloads for clients and is responsible for coordinating and managing healthcare and wellness services and resources for clients. This role involves liaising with healthcare...

  • Case Manager

    3 weeks ago

    Rancho Cucamonga, United States SIMPLE SOLUTIONS PSYCHOTHERAPY Full time

    Job DescriptionJob DescriptionBenefits:401(k) matchingDental insuranceFlexible scheduleFree food & snacksHealth insurancePaid time off Job Description: Our Case Manager manages caseloads for clients and is responsible for coordinating and managing healthcare and wellness services and resources for clients. This role involves liaising with healthcare...

  • Senior Case Manager

    1 month ago

    Rancho Cucamonga, United States Kaiser Permanente Full time

    Job Summary: Position located within the Correspondence center, reporting to the Correspondence Center Team Lead or Correspondence Center Assistant Director. Responsible for handling grievances and appeals review process through investigation, preparation, effectuation, and presentation of appropriate materials for review. Partner with internal and external...

  • Senior Personal Injury Case Manager

    1 month ago

    Rancho Cucamonga, United States Matian Firm Full time

    At The Matian Firm, our expert legal team is a driving force behind our continued success. Were in search of an experienced Senior Case Manager to join this team and help maintain the standard of excellence for which were known. The Personal Injury Case Manager will report directly to the Department Supervisor. This Senior Case Manager will participate in...

  • Senior Personal Injury Case Manager

    4 weeks ago

    Rancho Cucamonga, United States The Matian Firm, APC Full time

    Job DescriptionJob DescriptionAt The Matian Firm, our expert legal team is a driving force behind our continued success. We're in search of an experienced Senior Case Manager to join this team and help maintain the standard of excellence for which we're known. The Personal Injury Case Manager will report directly to the Department Supervisor. This...

  • Senior Personal Injury Case Manager

    3 weeks ago

    Rancho Cucamonga, United States The Matian Firm, APC Full time

    Job DescriptionJob DescriptionAt The Matian Firm, our expert legal team is a driving force behind our continued success. We're in search of an experienced Senior Case Manager to join this team and help maintain the standard of excellence for which we're known. The Personal Injury Case Manager will report directly to the Department Supervisor. This...

  • Case Manager RN/LVN

    2 weeks ago

    Rancho Cucamonga, United States Kindred Hospital Rancho Full time

    Description At Kindred It Starts With Me. Our commitment is to deliver excellence and an empathetic human experience to every patient, every family member, every employee, every time. We do this through our Core Values which help in guiding our work every day. Job Summary: The Case Manager I coordinates and facilitates the care of the patient...

  • Case Manager Assistant 10pm

    3 weeks ago

    Rancho Cucamonga, United States Hannah's Children's Homes Full time

    Job DescriptionJob DescriptionCase management assistants are responsible for overseeing several clients at a time, ensuring information is accurate, preparing and maintaining case files, and keeping detailed records of available community resources.Duties and ResponsibilitiesFile• Verifying individuals' informationEnsuring referral information is...

  • Utilization Review Case Manager

    1 month ago

    Rancho Cucamonga, United States CorVel Full time

    The Utilization Review Case Manager is responsible for reviewing inpatient and outpatient medical treatment to ensure its medical necessity and assigning appropriate length of stay. This is a remote position for candidates living in Pacific Time Zone. Essential Functions & Responsibilities: Communicate specific issues of concern with the appropriate claims...

  • Case Manager

    2 months ago

    Rio Rancho, United States FIVE SANDOVAL INDIAN PUEBLOS INC Full time

    GENERAL FUNCTIONS: Takes responsibility for the development of a case management plan based on a clinical case assessment for each client admitted to the program. Maintains ongoing case management planning and implementation for each client, evaluates all quarterly treatment reviews and plan revisions through a formal review system and provides regular case...

  • Case Manager

    3 weeks ago

    Rio Rancho, United States FIVE SANDOVAL INDIAN PUEBLOS INC Full time

    GENERAL FUNCTIONS: Takes responsibility for the development of a case management plan based on a clinical case assessment for each client admitted to the program. Maintains ongoing case management planning and implementation for each client, evaluates all quarterly treatment reviews and plan revisions through a formal review system and provides regular case...

  • Case Manager

    3 weeks ago

    Rio Rancho, United States FIVE SANDOVAL INDIAN PUEBLOS INC Full time

    GENERAL FUNCTIONS: Takes responsibility for the development of a case management plan based on a clinical case assessment for each client admitted to the program. Maintains ongoing case management planning and implementation for each client, evaluates all quarterly treatment reviews and plan revisions through a formal review system and provides regular case...

  • Case Management

    1 week ago

    Rancho Cordova, California, United States Blue Shield of California Full time

    Your RoleThe Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members' care including clinical nurses and treating physicians. The Registered Nurse Case Manager will report to the FEP...

  • RN-Manager Case Management

    1 month ago

    Rancho Mirage, United States Eisenhower Medical Center Full time

    * Share Job: * Email * Facebook * Linkedin chevron_left Back To Results Located in the heart of the Coachella Valley, you have access to resort-style living and world-class amenities throughout Southern California. * Job Objective: A brief overview of the position. * The position is responsible and accountable for the operations of the Case Management...