case manager Remote
Job description
Overview:
Our client, a Medical Center facility under the aegis of a California Public Ivy university and one of largest health delivery systems in California, seeks an accomplished Case Management Coordinator.
*** Candidate must be authorized to work in USA without requiring sponsorship ***
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*** Location: Los Angeles, CA 90024 (100% Remote Acceptable)
*** Duration: 3 months contract w/ possibility of extension
Description:
· Case Management Coordinator receives urgent, routine, pre-service and retro authorization requests and processes them through the referral and authorization procedures as established by the medical group utilization department.
· Responsible for prepping and processing referrals according to DOFR, posted guidelines, identifies documents needed to assist the next level of reviewer in review, and health plan contracts.
· Responsible for preparation and maintenance of specific reports and computer applications/logs.
· Monitors those members/patients followed by Case Management.
· Works directly with a nurse team lead. Reviews pending claims for approval or denial.
· Receives and processes complex referral authorization request. Must document research and findings in electronic health record or appropriate system. Runs reports utilizing the electronic medical records or appropriate system to aid in prioritizing, processing, or reporting on referrals.
· Researches health plan benefit and eligibility issues for each service and enters documentation of information into the managed care electronic health record module or appropriate system.
· Responsible for timely processing for all referral requests for services as per health plan requirements. Will notify supervisor in writing when unable to meet this requirement, including scanning and handling of pended referrals requiring additional review by nurse or physician.
· Serves as back up to others on the Case Management Team within the UM department and is able to perform all functions of the Case Management team.
· Receives telephone calls, e-mails, and all other electronic verbal or written correspondence regarding member referrals or issues. Resolves all inquiries within the same business day. May be required to document in the appropriate the managed care electronic health record system. Calls members, providers, and vendors to resolve issues or questions related to member referrals.
· Processes daily hospital admissions and reported out-of-area hospital admissions, documents the out-of-area admissions into the appropriate system.
· Initiates and maintains medical record files for patients meeting Case Management criteria or will document in the case management module in the electronic health record or appropriate system.
· Assists UM and QM Departments in the collection of information needed to respond to Appeals and Grievance cases and health plan audits.
· Reviews claims referred by the Claims Department for research and determination of approval or denial daily.
Qualifications:
· High school diploma, GED or equivalent.
· Experience working in a Managed Care environment preferred.
· Experience processing ambulatory Managed Care referrals.
· Vodavi phone system experience preferred.
· Ability to operate a wide variety of office equipment, including computers, printers, copy machines, facsimile receiver/transmitter, scanners, and mailing equipment.
· Proficient computer skills including working knowledge of Microsoft Excel and Word.
· Ability to multi-task, work with frequent interruptions and meet deadlines.
· Must be detailed oriented, attentive, organized, and able to follow directions.
· Ability to communicate thoughts and information clearly and succinctly in writing as well as verbally.
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I'd love to talk to you if you think this position is right up your alley, and assure a prompt communication, whichever direction. If you're looking for rewarding employment and a company that puts its employees first, we'd like to work with you.
Satwinder “Sat” Singh
Lead Technical Recruiter
Company Overview:
Amerit Consulting is an extremely fast-growing staffing and consulting firm. Amerit Consulting was founded in 2002 to provide consulting, temporary staffing, direct hire, and payrolling services to Fortune 500 companies nationally, as well as small to mid-sized organizations on a local & regional level. Currently, Amerit has over 2,000 employees in 47 states. We develop and implement solutions that help our clients operate more efficiently, deliver greater customer satisfaction, and see a positive impact on their bottom line. We create value by bringing together the right people to achieve results. Our clients and employees say they choose to work with Amerit because of how we work with them - with service that exceeds their expectations and a personal commitment to their success. Our deep expertise in human capital management has fueled our expansion into direct hire placements, temporary staffing, contract placements, and additional staffing and consulting services that propel our clients’ businesses forward.
Amerit Consulting provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Applicants, with criminal histories, are considered in a manner that is consistent with local, state and federal laws.
Job Types: Full-time, Contract
Salary: $18.00 - $21.00 per hour
Benefits:
- Health insurance
Schedule:
- 8 hour shift
- Monday to Friday
Education:
- High school or equivalent (Required)
Experience:
- Managed Care Environment: 1 year (Required)
- Processing Ambulatory Managed Care Referrals: 1 year (Required)
- Vodavi Phone System: 1 year (Preferred)
- Microsoft Excel: 1 year (Required)
- Microsoft Word: 1 year (Required)
- Case Management: 1 year (Required)
Work Location: Remote
