Case Coordinator
Primary Location Pleasanton, California
Worker Location Remote
Job Number 1314232 Date posted 12/20/2024
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Description:
Responsible for reviewing all incoming cases and triaging to Case Managers and Sr. Case Managers according to regulations. Prepares initial groundwork for appeals and grievances before handing-off case. Responsible for database accuracy and ensuring compliance.
Job Summary:
Responsible for reviewing all incoming cases and triaging to Case Managers and Sr. Case Managers according to regulations. Prepares initial groundwork for appeals and grievances before handing-off case. Responsible for database accuracy and ensuring compliance.
Essential Responsibilities:
- Participates in managing the organizations Complaint, Grievance, and Appeal process including: opening cases, including collection of appropriate data as directed. Ensures that flagged cases are triaged according to timeframes. Examines specialty cases and conducts initial groundwork before sending to Case Manager. Routes cases to Case Managers across Correspondence Centers according to capacity, especially in times of backlog.
- Prepares cases for audits and other state and federal governments. Ensures regulatory compliance with work product. Meets timeframes for performance while balancing the need to produce high quality work related to complex and sensitive member issues. Ensures integrity of departmental database by thorough, timely and accurate entry and closure of cases.
- Partners with and reaches out to internal staff, other MS Departments and managers to resolve issues as quickly as possible. Participates in departmental meetings, training and unit audits as requested. Escalates issues to management as appropriate to maintain compliance.
Basic Qualifications:
Experience
- Minimum one year experience in a service related industry.
Education
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- N/A
Additional Requirements:
- Strong working knowledge of federal and state laws and regulations and accreditation standards related to health care and managed care organizations.
- Ability to write clear, concise, grammatically correct resolution letters that meet regulatory and quality requirements.
- Excellent interpersonal, verbal and written communication skills.
- Ability to work with peers in self-managed teams to meet deadlines.
- Ability to use sound judgment and to handle potentially charged issues independently but with the knowledge and ability to escalate to the appropriate person / ask for help when needed.
- Ability to multitask and manage time in order to perform well on long term projects while being flexible enough to assimilate short term projects on an ongoing basis.
- Demonstrated ability to work in a time-sensitive environment.
- Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
- Knowledge of member grievance and appeals process preferred.
- Bachelors degree preferred.
Primary Location: California,Pleasanton,Pleasanton Tech Cntr Building F
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri * alternating weekends
Working Hours Start: 08:00 AM
Working Hours End: 05:00 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Remote
Employee Status: Regular
Employee Group/Union Affiliation: NUE-NCAL-09|NUE|Non Union Employee
Job Level: Entry Level
Department: PTC - 4460 Hacienda - A - Grp Rltn-Sales&Mrktng Integrtn - 0208
Pay Range: $56000 - $72380 / hour
Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data and a candidate's years of relevant work experience, education, certifications, skills, and geographic location.
Travel: No
Remote: Work location is the remote workplace (from home) within KP authorized states.
Worker location must align with Kaiser Permanente's Authorized States policy.
At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest
