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.