Remote Case Manager - Continuing Care at TEKsystems

Case Manager Continuing Care

Pay: $30 - $33 HR

Shift 9:00 am – 5:30 pm

Two days of training and pick up of equipment are onsite in Pasadena .

3 month contract with possibility of extension

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.

Preferred Qualifications:

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.

Required:

MSW required. If MSW is not obtained, LCSW will be considered acceptable, meeting this requirement.

o  Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: 

§  Medical, dental & vision 

§  Critical Illness, Accident, and Hospital 

§  401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available 

§  Life Insurance (Voluntary Life & AD&D for the employee and dependents) 

§  Short and long-term disability 

§  Health Spending Account (HSA) 

§  Transportation benefits 

§  Employee Assistance Program 

§  Time Off/Leave (PTO, Vacation or Sick Leave) 

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.