Case Manager

Immediate need for a talented Case Manager - Appeals and Grievances. This is a 06+ Months contract opportunity with long-term potential and is located in Pleasanton and Rancho Cucamonga, CA(Onsite). Please review the job description below and contact me ASAP if you are interested.

Job ID: 23-19784

Pay Range: $25- $38/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• 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.

Key Requirements and Technology Experience:

• Appeals & Grievances Experience.

• Case Management experience.

• 6 years of Customer Service.

• Heavy writing and speaking with customers over the phone.

• Microsoft Excel, word, really help.

• Healthcare environment is a plus.

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

Pyramid Consulting, Inc. 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.

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