Case Administrator Coordinator Position Available In Richland, South Carolina

Case Administrator Coordinator
Job Description

Role Name:

Case Administrator Coordinator

Location:

Columbia, SC 29229

Work Environment:

Remote (After Onsite training)

Schedule:

Mon to Fri, 6 am – 2:30pm OR 8:30 am – 5pm Contract length: 3 months assignment with possible conversion

Job Summary:

Duties/About the role:
Responsible for supporting and maintaining the coordination of daily operations of assigned area. Interfaces with the medical management on a regular basis to work more complex UR cases for the outpatient UR function. Day to

Day:

60% Maintains the outpatient authorization process to include ensuring benefit coverage, reviewing/determining eligibility, reviewing of established utilization review criteria, interpreting rules/regulations. Completes authorization by following established policies/procedures.
20% Reviews interdepartmental requests and medical information to complete utilization process.
15% Documents process used and decision in the appropriate system in accurate/timely manner.
5% Establishes/maintains effective business relationships with primary care physician offices, other providers of health services.

Team Info:

 My team is a mix of RNs and LPNs, that review denied claims for all service types in healthcare.

Any extra/additional job info:

NA Job Requirements:

Required Experience:

 3 years managed care in healthcare, physician’s office, or insurance company setting.

Required EDU:

 Other Degree – Graduate of Accredited School of Licensed Practical Nursing or Licensed Vocational Nursing.

Required Certification or licenses:

 Active, unrestricted LPN/LVN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted LPN license as defined by the Nurse Licensure Compact (NLC). Required Software and Tools (Hands on experience required): Microsoft Office
Soft skills: communication skills
Nice to have/Preferred skills: Any background with filing or reviewing appeals, post- service experience highly preferred. Background with billing and coding or claims review. Broad clinical background

About Us:

 Established in 2004, SPECTRAFORCE® is one of the largest and fastest-growing diversity-owned staffing firms in the US. The growth of our company is a direct result of our global client service delivery model that is powered by our state-of-the-art A.I. proprietary talent acquisition platform, robust

ISO 9001

2015/ISO 27001 certified processes, and strong and passionate client engaged teams. We have built our business by providing talent and project-based solutions, including Contingent, Permanent, and Statement of Work (SOW) services to over 140 clients in the US, Canada, Puerto Rico, Costa Rica, and India. Key industries that we service include Technology, Financial Services, Life Sciences, Healthcare, Telecom, Retail, Utilities and Transportation.

SPECTRAFORCE

is built on a concept of “human connection,” defined by our branding attitude of

NEWJOBPHORIA

®, which is the excitement of bringing joy and freedom to the work lifestyle so our people and clients can reach their highest potential.

Learn more at:

http://www.spectraforce.com

Benefits:

SPECTRAFORCE

offers ACA compliant health benefits as well as dental, vision, accident, critical illness, voluntary life, and hospital indemnity insurances to eligible employees. Additional benefits offered to eligible employees include commuter benefits, 401K plan with matching, and a referral bonus program.

SPECTRAFORCE

provides unpaid leave as well as paid sick leave when required by law.

Equal Opportunity Employer:

 

SPECTRAFORCE

is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at LOA@spectraforce.com if you require reasonable accommodation.

California Applicant Notice:

SPECTRAFORCE

is committed to complying with the California Privacy Rights Act (“CPRA”) effective January 1, 2023; and all data privacy laws in the jurisdictions in which it recruits and hires employees. A Notice to California Job Applicants Regarding the Collection of Personal Information can be located on our website. Applicants with disabilities may access this notice in an alternative format by contacting NAHR@spectraforce.com.

LA County, CA Applicant Notice:

If you are selected for this position with SPECTRAFORCE, your offer is contingent upon the satisfactory completion of several requirements, including but not limited to, a criminal background check. We consider qualified applicants with arrest or conviction records for employment in accordance with all local ordinances and state laws, including the Los Angeles County Fair Chance Ordinance for Employers (FCO) and the California Fair Chance Act (FCA). The background check assessment will consider whether a criminal history could reasonably have a direct, adverse impact on the job-related safety, security, trust, regulatory compliance, or suitability for this role. Such findings may result in withdrawal of a conditional job offer. At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $22.00/hr.