Remote Claims Supervisor Jobs in Riverside, CA (NOW HIRING)

Vivo HealthStaff is actively recruiting for a fully remote Case Manager position. This temporary 3-month contract role, with an option to extend, and focuses on health care management and coordination for members with complex and chronic care needs. Utilizing the nursing process, the Case Manager will interact effectively with members, caregivers, and interdisciplinary team participants, all while working remotely.
Job Description:
- Care Coordination: Serve as a remote resource for the member, their family, and their physician, ensuring access to appropriate care and facilitating referrals/authorizations.
- Comprehensive Assessments: Conduct thorough remote assessments, evaluating the member's health status, resource utilization, and treatment plans.
- Care Plan Implementation: Collaborate remotely with the member, PCP, and care team to implement a care plan, interfacing with various healthcare professionals.
- Education and Support: Provide remote education and self-management support tailored to the member's unique learning style.
- Problem Solving: Assist in resolving issues with providers, claims, or services from a remote setting.
- Care Coordination Efficiency: Work closely with delegated or contracted providers to ensure effective care coordination, remotely.
- Compliance: Maintain confidentiality of all PHI in compliance with state and federal law and company policy, while working remotely.
Supervisory Responsibilities:
- None.
Minimum Requirements:
Experience:
- 1-3 years of clinical experience, with 2 or more years in case management.
- Health Plan experience preferred.
Education/Licensure:
- Active, valid, and unrestricted California RN license.
Other Skills:
- Understanding of community resources, treatment options, home health, funding options, and special programs.
- Extensive knowledge of chronic condition management.
- Bilingual in Spanish preferred.
- Excellent verbal and written communication skills.
- Team player with effective relationship-building skills.
- Ability to work independently in a remote setting.
- Experience using standardized clinical guidelines.
- Strong organizational skills.
- Proficiency in PC-based software programs, including Word, Excel, and PowerPoint.
Vivo HealthStaff is a healthcare staffing and recruitment firm based in the San Francisco Bay Area, providing permanent and temporary opportunities to organizations across the United States.