Case Manager

This range is provided by Artech L.L.C.. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Corona, CA / Portland, OR - Remote

12+ Months Contract

$30.00/hr - $35.00/hr on W2

Within 100 miles of mentioned location.

Required Level of

Education:

HS Diploma but bachelor’s is preferred.

Experience required: 6 years customer service, heavy writing and speaking with customers over the phone. Microsoft Excel and Word. Healthcare environment is a plus. Blue Shield, Aetna, Healthcare providers (this is a huge plus).

Monday-Friday, 8:30am-5pm with opportunities for overtime.

1 phone interview (Teams preferred if possible).

• Research and respond to member grievances and appeals

• Background in grievance and appeals case processing.
• Strong organizational and time management skills.
• Ability to multi-task in a fast-paced environment.

• 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.

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 time frames.

• Participates in handling the grievances, appeals/denials process. Ensures appeals are processed in accordance with regulations, compliance standards and policies and procedures. Meets time frames 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 members 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. Answers questions and manages members on existing / open cases.

• Mid-Senior level

• Contract

• Administrative and General Business
• Hospitals and Health Care