An important client is hiring a Case Manager!
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 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.
Requirement:
The ideal candidate will possess the following:
Required Level of Education and Preferred Level of Education: MSW required If MSW is not obtained, LCSW will be considered acceptable, meeting this requirement How many years of related experience are you looking for in your ideal candidate? 2 years Specific Systems Knowledge Required: Basic computer skills required Specific Systems Knowledge Preferred: Epic experience is a huge plus.
REQ SPECIFIC MUST HAVES: Exceptional customer service, be able to think on their feet, get along well with the team, and have ability to look at a case holistically Be willing to learn if needed about the medical pieces Be willing to reach out to team members for support Write basic care plans: such that, if exercise is required, will list walk 4x a week for 30 minutes, schedule follow up appointments with specialty doctor every 6 weeks (as reference by doctor in chart), etc Bigger picture thinking and recognize when something is emergency Knowledge of managed care is great Will be supporting Medical/Medicare population Great listening skills and be able to pivot and think of next best questions to ask the patient, etc.
Minimum Work Experience and Qualifications: Experience in a service related industry, call center experience preferred Excellent interpersonal, verbal and written communication skills Ability to work with peers in self-managed teams Ability to prioritize work and ensure all compliance elements are met Demonstrated conflict resolution and mediation skills with ability to secure action from multiple stakeholders Ability to use sound judgment and to handle complex issues independently, but with the knowledge and ability to escalate and ask for help when needed Demonstrated ability to work in a time-sensitive environment involving patients, family members and advocates Extensive working knowledge of personal computers to include Windows based software applications, MS Word, etc (added) Ability to multitask and manage time in order to perform well on long term projects while being flexible enough to assimilate short term projects on an ongoing basis Must be able to work in a Labor/Management Partnership environment Preferred Work Experience and Qualifications: Experience in a complex health care environment preferred Strong working knowledge of federal and state regulations, laws and accreditation standards related to health care and managed care organizations Knowledge of member complaint and grievance processing preferred Competent working knowledge of KP Health Plan benefits plan/contracts/systems strongly preferred Educational requirement - high school diploma or GED required Some college preferred ENTER YEARS OF EXPERIENCE REQUIRED:
Benefits:
Benefits
Full-time employees (working an average of 30 hours or more) are eligible to select from different benefits packages Packages may include medical, dental, and vision benefits, a 401(k) retirement savings plan with employer match (available after 1 year of employment), commuter benefits, employee discount and referral programs, and life and supplemental income insurance Paid sick leave is provided in accordance with applicable state and local laws.
Compensation
Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience, as well as the benefits package you select.
Work Authorization
ATR International, Inc cannot sponsor work visas (H-1B, F-1 STEM OPT with I-983, or similar) Candidates must have valid U.S work authorization.
ATR International, Inc is an equal opportunity employer We celebrate diversity and are committed to creating an inclusive environment for all employees.