Medical Case Worker

  • location: Rancho Cucamonga, CA
  • type: Temporary
  • salary: $48 - $50 per hour
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job description

Medical Case Worker

Job Summary:
Do you enjoy helping customers with their grievances? Do you have an understanding of the grievance process as it relates to healthcare plans and healthcare providers? Are you up for the challenge in working in a high volume and fast-paced setting? If so, and the job description matches your skill sets, one of the largest healthcare and insurance providers is seeking driven leaders to join their organization.

If you have a positive, professional demeanor, and understands what it takes to be a successful, this is perfect for you!

** For a quicker response time, feel free to apply by emailing me at widlyn.daniels@randstadusa.com a MS Word version of your resume then texting me at 707-733-3120 with subject line "Case Manager" **

Duration: 9 months (may convert)
Shift/hours: 40 hours, F/T, M-Fri
Pay Range: $$99,840-$104,000 annually
Parking FEE: FREE
Location: Rancho Cucamonga, California 91730

Responsibilities:
Case Processing and/or health care experience a MUST
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
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

Working hours: 8:00 AM - 6:00 PM

Skills:
Case Processing and/or health care experience a MUST
Customer Service Skills
Ability to deescalate & investigate grievances and complaints all by phone
Ability to multi-task under pressure and deliver performance expectations
Case Processing and/or health care experience a MUST

Education:
High School

Experience:
Experienced

Qualifications:
High School Diploma
2 years?? experience in a complex health care environment PREFERRED
Working knowledge of federal and state regulations, laws and accreditation standards related to health care and managed care organizations REQUIRED
Knowledge of member complaint and grievance processing PREFERRED
Competent working knowledge of KP Health Plan benefits plan/contracts/systems PREFERRED


** For a quicker response time, feel free to apply by emailing me at widlyn.daniels@randstadusa.com a MS Word version of your resume then texting me at 707-733-3120 with subject line ??Case Manager?? **

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad. EEO Employer: Race, Religion, Color, National Origin, Citizenship, Sex, Sexual Orientation, Gender Identity, Age, Disability, Ancestry, Veteran Status, Genetic Information, Service in the Uniformed Services or any other classification protected by law. San Francisco Fair Chance Ordinance: Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.
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