Case/Care Manager

Adecco is currently assisting a local client in their search to fill a Case/Care Manager position in San Francisco, CA! This is a long-term opportunity for the right person. If you would like to pursue a great opportunity and enjoy working for a fast-paced company, then Apply Now if you meet the qualifications listed below!

1. Knows, understands, incorporates, and demonstrates the Optum360 and client Mission, Vision, and Values in behaviors, practices, and decisions.
2. Demonstrating excellent customer service skills by facilitating communication between the hospital facilities and the payers.
3. Demonstrating effective assessment skills relative to providing adequate documentation and/or response as requested and/or required by the payers.
4. Accommodating payer requests for clinical reviews and Medical Record
5. Facilitating verbal discussion between the respective facility and the payer, as required.
6. Becoming knowledgeable of payer assigned time frames.
7. Understanding specific payer UM details.
8. Collaborating and alerting facility Case Managers of:
a. Additional payer needs
b. Requests for concurrent or retrospective review
c. Physician Advisor review
9. Providing support in the certification process to ensure timely authorization of inpatient days followed by timely and accurate documentation.
10. Providing communication and/or documentation, as required, in order to ensure concurrent certification and payer updates via MIDAS.
11. Facilitating the scanning, copying, and mailing of documents for deferred cases or for cases involved in a concurrent clinical appeal.
12. Performing tasks within current systems (PAI, Midas, Invision, MS4 Meditech) to ensure documentation of TAR and commercial clinical denials.
13. Tracking Medicaid/Medi-Cal cases to ensure timely receipt of any concurrent appeal decision by the payer.
14. Monitoring payer and State portals and websites for documents related to commercial certification, Treatment Authorization Request (TARs), and Service Authorization Request (SARs)
15. Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Optum360s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
16. Other duties as needed and assigned by the Manager.

• Must be proficient in Microsoft Office, including; Word, Excel, and Outlook
• Knowledge of Medical Terminology through college level coursework or at least 2 years of on-the-job training
• High School Diploma or GED, required

Preferred but not required:
• Minimum of 2 years in Acute Care Facility or Centralized Business Office performing one of various functions including Billing/Coding, Balance after insurance or self-Pay Collections, Appeals processing, Patient Access Department Patient Scheduling, Pre-Service/Financial Clearance, Registration, Financial Counseling, or other functions related to revenue cycle activities in a complex, multi-site environment preferred.

HOW TO APPLY: Candidates interested in this Opportunity should apply IMMEDIATELY. Please click on the “Apply Now” button to fill out your application.

IMPORTANT INFORMATION: This position is being recruited for by Adecco’s Service Delivery Center, not your local Adecco Branch Office. To be considered for this position, you must use the “apply now” button to submit your resume. If you have questions about the position, you may contact the recruiter recruiting for this position listed above, however your resume must be received via the “apply now” button included within to be considered.

The Adecco Group is a global leader in HR services. Our group connects over 700,000 associates with our business clients each day through our 6,600 offices in over 70 countries and territories around the world. We offer employment opportunities at any stage in your professional career. Contact us today to discuss available contract and direct hire positions. Adecco Group offers benefits including Holiday, 401(k), Insurance Benefit Plans and Service/Anniversary Bonus opportunities.

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Reference number US_EN_99_022862_1189233