nurse case manager

Our client is a leading healthcare company with an urgent need for an experienced Case Manager in Rancho Cucamonga, CA! This position will start onsite for several weeks for training, before being remote. Candidates will still need to live within a commutable distance, as this position could return to office full-time in the future. This is a one-year assignment, with potential to extend.  The ideal candidates has 6+ years of healthcare customer service experience, specifically handling grievances, appeals, and escalations. The Case Manager will communicate heavily with customers/patients over the phone and in virtual meetings. Bachelor's degree highly preferred.salary: $34 - $39 per hourshift: Firstwork hours: 8:30 AM - 5 PMeducation: BachelorsResponsibilities Participate in managing the organization's complaint and grievance/appeals process (required) 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. SkillsHealthcareCertified Case Manager (CCM)Healthcare NetworkHealthcare LawHealthcare System NavigationOrganizationPrioritizingWorking IndependentlyDecision MakingAnswering PhonesOral CommunicationHandling Confidential InformationProblem SolvingWritten CommunicationMicrosoft OfficeGrievances and AppealsEscalationsConflict ResolutionHealthplanCorrespondenceHealthcare Customer ServiceQualificationsYears of experience: 0 yearsExperience level: 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. Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including health, an incentive and recognition program, and 401K contribution (all benefits are based on eligibility).Applications accepted on ongoing basis until filled. Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance. We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.

Medical Office Assistant - Part Time (On-Site) (24 hours weekly) We are hiring for a professional and experienced medical office assistant to fulfill a part time role with a reputable chiropratic office in Saint Petersburg, FL. This role does not require medical experience or any healthcare experience but is a plus. This role will be mostly responsible of working alongside the lead technician as the office assistant as well as scheduling patients and front desk duties. If you are open to a part time role with flexibility and possibility of mvoing to full time career, this is for you! Apply Today! Benefits!salary: $18 - $21 per hourshift: Firstwork hours: 9 AM - 5 PMeducation: AssociateResponsibilities Maintaining a professional and customer focused attitude Scheduling appointments for ongoing customers Maintaining and ordering office supplies Communication and appointment reminders to active patients as well as new incoming patients Possibility of medical billing Verifying insurance  Answering incoming calls and greeting patients positively and professionally The essential functions of this role include:working in a smoke free environmentSkillsMicrosoft Office (3 years of experience is preferred)Excel (2 years of experience is required)Time ManagementScheduling Appointments (1 year of experience is required)Administrative Duties (1 year of experience is required)Customer Service (2 years of experience is required)OrganizationPatient Care CoordinationPatient Scheduling (1 year of experience is preferred)Medical SoftwareReceiving Incoming CallsMacintosh (1 year of experience is required)QualificationsYears of experience: 2 yearsExperience level: ExperiencedRandstad 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. Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including health, an incentive and recognition program, and 401K contribution (all benefits are based on eligibility).Applications accepted on ongoing basis until filled.

A trusted client of Randstad's has an immediate opening for an experienced Grievance and Appeals Coordinator. This is a hybrid role located in Columbus, OH. First month would be fully onsite with hybrid worked in after. Must be experienced with grievance and appeals, claim denials, medical terminology and CPT codes. If interested, apply and send your resume with the subject line "Grievance and Appeals" to megan.perri@randstadusa.comsalary: $19.99 - $20 per hourshift: Firstwork hours: 8 AM - 5 PMeducation: High SchoolResponsibilities Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. Gather, analyze and report verbal and written member and provider complaints, grievances and appeals Prepare response letters for member and provider complaints, grievances and appeals Maintain files on individual appeals and grievances May coordinate the Grievance and Appeals Committee Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research. Manage large volumes of documents including copying, faxing and scanning incoming mail SkillsClaim DenialsCPT CodesQualificationsYears of experience: 1 yearExperience level: ExperiencedRandstad 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. Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including health, an incentive and recognition program, and 401K contribution (all benefits are based on eligibility).Applications accepted on ongoing basis until filled.