Mastech Digital is an IT Staffing and Digital Transformation Services company.

Senior Case Manager

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Location: Rancho Cucamonga, CA
Job Code: 221957
Posted: Nov 20, 2020

Mastech Digital provides digital and mainstream technology staff as well as Digital Transformation Services for all American Corporations. We are currently seeking a Senior Case Manager for our client in the Healthcare domain. We value our professionals, providing comprehensive benefits and the opportunity for growth. This is a Contract position and the client is looking for someone to start immediately.

Duration: 12 Months Contract

Location: Rancho Cucamonga, CA

Role: Senior Case Manager

Primary Skills: Organization Development

Role Description:
The Senior Case Manager must have at least 2+ years of experience. In this role, you will be responsible for handling the review process for grievances, appeals, or denials including investigating, preparing and presenting appropriate materials for review. 

You will resolve member concerns in partnership with internal and external departments while ensuring compliance with regulatory rules and timeframes, within mandated timeframes and compliance.

Top Daily Responsibilities:

- Research and respond to member grievances and appeals

- Meet regulatory requirements

- Improve Member Experience

Top (3) Required Skills:

- Background in grievance and appeals case processing.

- Strong organizational and time management skills

- Ability to multi-task in a fast-paced environment

Additional Skills Preferred:

- Strong knowledge of federal & state regulations and Medicare/Medi-Caid regulations.

- Ability to compose high quality, detailed written communication.

- Excellent interpersonal, verbal and written communication skills.

Essential Functions:

- Participates in handling the grievances, appeals/ denials process. 

- Ensures appeals are processed in accordance with regulations, compliance standards and policies and procedures. 

- Meets timeframes for performance while balancing the need to produce high quality work related to complex and sensitive member issues.

- Investigates all issues, including collection of appropriate data, preparation and presentation of documents to decision makers. 

- Informs members or their authorized representatives, physicians and other stakeholders of Health Plan's determinations.

- Collaborates with internal staff, other MS Departments, managers and physicians to seek resolution on issues and cases affecting member while ensuring compliance, documentation and enhancing members' experience. 

- Ensures integrity of departmental database by thorough, timely and accurate entry.

- Mentors others in preparation for positions of increased responsibility. 

- Participates in departmental meetings, trainings and audits as requested. 

- Answer questions and manages members on existing/open cases.

Education: High School/Bachelor’s degree in Computer Science, Electrical/Electronic Engineering, Information Technology or another related field or Equivalent.

Experience: Minimum 2+ years

Relocation: This position will not cover relocation expenses

Travel: No

Local Preferred: Yes

Recruiter Name: Rajiv Kumar

Recruiter Phone: 412.436.0333 (Ext: 2228)

Equal Employment Opportunity

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