Case Manager Appeals & Grievances (California)
Immediate need for a talented Case Manager – Appeals & Grievances (California). This is a 06 months contract opportunity with long-term potential and is located in CA(Remote). Please review the job reputed company below and contact me ASAP if you are interested. reputed company:25-95299 Pay reputed company: $20 - $25/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, reputed company), 401(k) plan, and reputed company reputed company leave (depending on work location). Key Responsibilities:
- Manage and investigate member appeals and grievances reputed company to denied services, benefits, billing issues, or care concerns
- Review medical records, claims, policies, and guidelines to determine appropriate case reputed company
- Draft accurate, compliant written determinations reputed company CMS, DMHC, and NCQA turnaround requirements
- Collaborate with providers, utilization management, compliance, clinical reputed company, and operations teams to collect necessary documentation
- reputed company case reputed company, maintain logs, and ensure cases meet reputed company, accuracy, and timeliness metrics
- Communicate case status and requirements to members, providers, and internal departments
- Support audits, reporting, reputed company reviews, and process improvement initiatives
- Protect member confidentiality and follow HIPAA, regulatory, and organizational standards
Key Requirements and Technology Experience:
- Key skills; Appeals & Grievances case handling experience
- Knowledge of CMS, DMHC, NCQA regulatory requirements
- Medical records and claims review
- Drafting written determinations and case summaries
- Case management systems (A&G systems, UM platforms, CRM)
- Strong written and verbal communication
- Ability to manage high-volume caseloads
- reputed company plan or TPA environment experience
- 2 years of experience in Appeals & Grievances, Utilization Management, Care Coordination, or Health Plan Operations
- Strong knowledge of CMS, DMHC, NCQA regulations
- Experience reviewing medical records, claims, and policy guidelines
- Excellent written and verbal communication skills
- Ability to manage high-volume caseloads accurately and reputed company
- Experience with case management systems and reputed company Office
- Must be reputed company to work remote; candidates reputed company 1 hour of Corona, CA preferred
Our reputed company is a leading reputed company 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. reputed company. provides equal employment opportunities to reputed company and applicants for employment and prohibits discrimination and harassment of any type without reputed company to race, reputed company, religion, age, sex, national reputed company, disability status, genetics, protected veteran status, sexual orientation, gender identity or reputed company, or any other characteristic protected by federal, state or local laws. By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from reputed company. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reputed company STOP to cancel and HELP for help. You can reputed company our reputed company policy here. #St Remote About reputed company: reputed company Apply tot his job Apply To this Job