Case Management Processor (Full Remote)

Job Title: Case Management Processor

Pay Range: $24.00 per hour

Temp-to-Permanent - permanent eligible after 13 weeks

Schedule: Full-time, Monday to Friday, 8:30 am - 5:00 pm PST

Location: 100% Remote

Position Overview:

Eligible candidates must live in PST Time Zone. We are seeking a Case Management Processor to join a national Managed Care Organization on a temporary-to-permanent basis. The Case Management Processor will provide non-clinical support to the Case Management team, ensuring that tasks are managed efficiently and that members receive timely and effective care.

Duties and Responsibilities: • Provide administrative support to the Case Management staff, performing non-clinical activities and assisting in managing department tasks. • Conduct initial review and triage of Case Management tasks, helping to prioritize case needs. • Review data to identify key member needs and work under the direction of the Case Manager to implement care plans. • Screen members using organizational policies and procedures, assisting the clinical team in identifying appropriate medical services. • Coordinate necessary services based on the member’s benefit plan. • Foster communication internally and externally to improve the effectiveness of case management services (including communication with healthcare providers and team members). • Generate and review reports to assist in the coordination of case management activities. • Provide telephone support, take messages, and research information to support the Case Management team. • Maintain accurate and complete documentation that complies with risk management, regulatory, and accreditation requirements. • Ensure the confidentiality of member information in line with company and regulatory standards.

Knowledge, Skills, and Abilities:
• Excellent customer service skills with the ability to coordinate service delivery, paying close attention to member needs and proactively resolving issues.
• Demonstrated ability to effectively communicate and problem-solve while working with diverse individuals.
• Working knowledge of medical terminology and abbreviations.
• Strong analytical and problem-solving skills.
• Strong interpersonal and team collaboration skills.
• High regard for confidential information and adherence to HIPAA compliance.
• Ability to work independently in a fast-paced environment as well as part of a team.
• Proficient in PC usage with experience in a Windows environment and accurate data entry (minimum 40 WPM).
• Ability to establish and maintain positive work relationships with coworkers, clients, members, and providers.

Education and Experience:
• Required Education: High School Diploma or G.E.D.
• Required Experience: 1-3 years of experience in an administrative support role in healthcare.
• MUST LIVE IN CST Time Zone

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