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Case Manager
Case ManagerArtech LLC • Pasadena, CA
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Case Manager

Case Manager

Artech LLC • Pasadena, CA
30+ days ago
Job type
  • Full-time
Job description

Job Title : Case Manager

Location : Remote

Pay Range : $35 / hr on W2

Introduction

We are seeking a dedicated and detail-oriented professional to join our team as a Case Manager. This role offers the opportunity to make a meaningful impact by managing and resolving complaints and grievances while ensuring compliance with regulations and enhancing member experiences.

Required Skills & Qualifications

  • Applicants must be able to work directly on a W2 basis.
  • Experience in a service-related industry, with call center experience preferred.
  • Excellent interpersonal, verbal, and written communication skills.
  • Demonstrated conflict resolution and mediation skills with the ability to secure action from multiple stakeholders.
  • Ability to use sound judgment and handle complex issues independently, with the knowledge to escalate and ask for help when needed.
  • Extensive working knowledge of personal computers, including Windows-based software applications and MS Word.
  • Must be able to work in a Labor / Management Partnership environment.

Preferred Skills & Qualifications

  • Experience in a complex healthcare environment preferred.
  • Strong working knowledge of federal and state regulations, laws, and accreditation standards related to healthcare and managed care organizations.
  • Knowledge of member complaint and grievance processing preferred.
  • Competent working knowledge of health plan benefits, plan / contracts / systems strongly preferred.
  • Some college education preferred.
  • Day-to-Day Responsibilities

  • Participate in managing the organization's complaint and grievance process.
  • Investigate all issues, including the 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 complaint and grievance handling, compliance, documentation, and enhancement of the member experience.
  • Partner with and outreach to internal staff, other departments, managers, and physicians to resolve issues as quickly as possible.
  • 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.
  • 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.
  • Company Benefits & Culture

  • We offer a supportive and inclusive work environment that values diversity and encourages collaboration.
  • Opportunities for professional development and growth.
  • Comprehensive benefits package tailored to meet the needs of a diverse workforce.
  • For immediate consideration please click APPLY to begin the screening process.

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    Case Manager • Pasadena, CA

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