ATR International · 10 hours ago
Case Manager
Pasadena, CA
Contract
Onsite
New Grad, Entry Level
$27/hr - $33/hrATR International is seeking a Case Manager to manage the organization's complaint and grievance process. The role involves investigating issues, communicating with clients, and ensuring compliance with regulations while enhancing member experiences.
Human ResourcesRecruitingStaffing Agency
Hiring Manager
Christian Wong
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
Meet timeframes for performance while balancing the need to produce high quality work related to complex and sensitive member issues
Ensure integrity of departmental database by thorough, timely and accurate entry, consistent with regulatory protocols and effectively manage case resolution inbox everyday
Participate in departmental meetings, trainings and audits as requested
Answer questions and manage members on existing / open cases
Escalate issues to management as appropriate to maintain compliance
Qualification
Required
Experience in a service related industry
Excellent interpersonal, verbal and written communication skills
Ability to work with peers in self-managed teams
Ability to prioritize work and ensure all compliance elements are met
Demonstrated conflict resolution and mediation skills with ability to secure action from multiple stakeholders
Ability to use sound judgment and to handle complex issues independently, but with the knowledge and ability to escalate and ask for help when needed
Demonstrated ability to work in a time-sensitive environment involving patients, family members and advocates
Extensive working knowledge of personal computers to include Windows based software applications, MS Word, etc
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
Must be able to work in a Labor/Management Partnership environment
Educational requirement - high school diploma or GED required
Preferred
Call center experience preferred
Experience in a complex health care environment preferred
Strong working knowledge of federal and state regulations, laws and accreditation standards related to health care and managed care organizations
Knowledge of member complaint and grievance processing preferred
Competent working knowledge of Health Plan benefits plan/contracts/systems strongly preferred
Some college preferred
Company
ATR International
ATR International is a technical staffing firm that offers staffing and consulting services.
Founded in 1988
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Jerry Brenholz
Co-Founder
Recent News
2025-06-21
2025-06-21
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