Case administrator job description

You will work with a dedicated group of professionals in our New York City office and will be responsible for providing administrative support on arbitration cases and performing data entry tasks in accordance with the rules and procedures of the AAA and applicable law. This is an exciting opportunity for an individual seeking a career in the legal industry who prides themselves on professionalism, client service, communications abilities, and problem-solving skills.

The successful applicant will work on a hybrid basis (approximately 50% on-site) or fully remote. Fully remote employees must work from their primary residence, which must be located within a commutable, 100-mile radius of the regular AAA worksite. The starting annual equivalent salary range for this position is $54,200 - $57,330, and a 7.5% incentive opportunity.

Named as one of the 50 best nonprofits to work for by the Non-Profit Times, our employees enjoy rewarding careers in a fast-paced, results-driven environment. Our employees also participate in a comprehensive benefits program that includes medical, dental, orthodontia, and vision coverage, a student loan repayment program, a 403(b) retirement plan with substantial company match, discounted pet insurance, and generous paid time-off benefits.

COVID -19 INFORMATION: Unvaccinated individuals will be required to wear a well-fitted face mask at all times when on-site, where 6 feet of social distancing cannot be maintained. Vaccinated individuals are exempt from this requirement, provided they provide proof of full vaccination. Additionally, a New York City Commissioner of Health and Mental Hygiene Order stipulates that workers in New York City must show proof of vaccination. Employees may request an accommodation for medical or religious reasons.
Responsibilities

Reviews case-related documents received from internal and external parties; uploads documents into system, enters data, records, logs, reports, and sends correspondence; Ensures correct identification and categorization of documents, entry of data, logs, reports and correspondence.
Provides information regarding procedural, billing and case status questions; reviews stipulations, court orders, insurance policies, and other legal documents; disseminates correspondence, and updates case status and schedules hearings.
Initiates and maintains an efficient flow of information; processes arbitrator dispositions and adjournment requests; manages arbitrator's calendar; responds to inquiries related to arbitration cases; monitors and follows up to ensure cases are submitted; arranges phone conferences to ensure timely transmittal of case related correspondence.
Determines and assigns medical professionals per request of arbitrator to review independent medical exams provided by parties.
Articulates and demonstrates advanced knowledge of arbitration sections of NYS Regulation 68 and NYS Regulation 35D related to NYSI Division's operations and tasks specific to their role and departments; Appropriately addresses inquiries from parties; elevates complex inquiries as needed; Demonstrates advanced knowledge of NYS insurance forms and/or related documents related to NYS Regulation 68 and/or NYS Regulation 35D and NYSI procedures.
Ensures confidentiality of case information and case records; adheres to the AAA's information security and data privacy policies, procedures, and practices.
Completes assigned tasks in online case management system, which includes capturing settlement agreements, inputting billing and check requests, reviewing the case financials, review and send awards, processing withdrawals, processing telephonic requests, reviewing messages, processing technical corrections, abeyance requests, and answering party and arbitrator inquiries.
Establishes a professional rapport with the user community, stakeholders, and internal associates; maintains neutrality; responds to inquiries in a timely manner; anticipates, troubleshoots and resolves problems by weighing the importance of facts and issues in a manner that fosters resolution and efficient management of cases; ensures that unresolved and complex issues are escalated to the appropriate supervisor.
Demonstrates regular, reliable, and predictable job attendance.
Attends on-site and in-person meetings and training sessions.

Qualifications

Education & Experience: Associate's degree in business or related discipline; 0-2 years of relevant work experience (e.g. -customer service, medical/liability insurance, case administration, legal environment); or an equivalent combination of education and work experience.

Language Skills: Ability to read and interpret documents such as legal files, business correspondence and procedure manuals; ability to write routine reports and business correspondence; ability to speak effectively, both in person and by telephone, to customers, attorneys, arbitrators, mediators and employees of the organization.

Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists; ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form.

Technical Skills: Intermediate proficiency with Microsoft Excel, Word, and web-based case management systems.

The American Arbitration Association is an equal opportunity employer (EEO) and considers all employees and applicants for positions without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, marital status, or status as a covered veteran in accordance with applicable federal, state and local laws.

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You will work with a dedicated group of professionals and will be responsible for providing administrative support on arbitration and mediation cases in accordance with the rules and procedures of the AAA and applicable law. This is an exciting opportunity for an individual seeking a career in the legal industry who prides themself on professionalism, client service, communications abilities, and problem-solving skills.

The successful applicant will work from Los Angeles, CA, on a hybrid basis (approximately 50% on-site). The salary range for this position is $48,700 - $51,550 / year, and quarterly incentive opportunities.

Named one of the 50 best nonprofits to work for by the Non-Profit Times, our employees enjoy rewarding careers in a fast-paced, results-driven environment. We offer a competitive compensation package, including incentives. Eligible employees also participate in a comprehensive benefits program that includes medical, dental, orthodontia, vision coverage, a student loan repayment program, a 403(b) retirement plan with substantial company match, discounted pet insurance, and generous paid-time-off benefits.

COVID -19 INFORMATION: Unvaccinated individuals will be required to wear a well-fitted face mask at all times when on-site, where 6 feet of social distancing cannot be maintained. Vaccinated individuals are exempt from this requirement, provided they provide proof of full vaccination. Additionally, a New York City Commissioner of Health and Mental Hygiene Order stipulates that workers in New York City must show proof of vaccination. Employees may request an accommodation for medical or religious reasons.

+ Assists in administering arbitration and mediation cases; communicates regularly with parties, party representatives, and arbitrators and mediators by telephone, email, and letter; performs scheduling and other administrative tasks.

+ Understands and applies rules and procedures for administering arbitration and mediation cases, including fee and billing policies; interprets and determines their appropriate application to assigned cases.

+ Maintains and updates case files, records, and documents in the online case management system (PRISM).

+ Ensures confidentiality of case information and case records; adheres to the AAA's information security and data privacy policies, procedures, and practices.
+ Assists in coordinating, initiating, and administering conference calls and video conferences.

+ Applies correct case fee schedules; accurately calculates and allocates billings/cancellations based on fee schedules and contractual agreements; explains fee calculations and billing processes to customers.

+ Prepares and sends electronic and written communications to parties, party attorneys, arbitrators, and mediators.

+ Proactively identifies case management issues, informs management, and takes appropriate action to resolve them.

+ Responds to inquiries from clients, client representatives, and panelists in a timely and courteous manner; assists managers with informing and educating clients and client representatives on ADR processes. Provides feedback to management regarding interaction with arbitrators and mediators.

+ Demonstrates regular, reliable, and predictable job attendance.

+ Attends on-site and in-person meetings and training sessions.

Education & Experience: Associates degree in business or related discipline; 2-4 years of relevant work experience (e.g., customer service, case administration, legal environment) or an equivalent combination of education and work experience.

Language Skills: Ability to read and interpret documents such as legal files, business correspondence, and procedure manuals; ability to write routine reports and business correspondence; ability to speak effectively, both in person and by telephone, to customers, arbitrators, mediators or employees of the organization.

Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals; ability to compute rate, ratio, and percent and to draw and interpret bar graphs; ability to understand and interpret statistical reports, data charts, and graphs.

Computer Skills: Intermediate proficiency with Microsoft Outlook, Word, Excel, and web-based case management systems.

The American Arbitration Association is an equal opportunity employer (EEO) and considers all employees and applicants for positions without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, marital status, or status as a covered veteran in accordance with applicable federal, state and local laws.


External Company URL: www.adr.org

Street: 725 S. Figueroa Street

At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your future!

Job Summary

Case Management (Cm) And Disease Management (Dm). Is A Single Source Of Contact For Members, Health Care Personnel And All Other Entities Involved In Managing Care. The Primary Nurse Coordinator Performs Concurrent Review, Discharge Planning And Care Coordination. Identifies Alternate Treatment Programs; Consults With Physicians, Providers, Members, And Other Resources To Evaluate Options And Services Required To Meet An Individual *S Health Needs. Promotes Quality And Cost Effective Outcomes; And Serves As Liaison To Physicians And Members. Other Functions Also Include Episodic Case Management, Determining Member Assignment Of Treatment, And Pre-Admission/Post-Discharge Counseling For An Acute Condition. Establish Relationship With The Member Through The Immediate Post Discharge Follow-Up Period Or Until All Short Term Care Needs Are Met. Provide Education/Local Resource Information And Encourage Member (Self) Education. Functioning In A Clinical Care Advisory Role, The Primary Nurse Coordinator Assesses Members For Wellness Education And Disease Management, Introduces Members To Our Website Tools, Educates Members Regarding Wellness And Specific Conditions, And Facilitates The Coordination Of Care For Identified Members.

Responsibilities

1. Perform concurrent review, discharge planning, and alternate treatment programs. Consult with physicians, hospital UR, Coordinators and hospital discharge planners to determine other resources and appropriate disposition of such cases. May do on-site review of cases.

2. Apply accepted department criteria to reviews for medical necessity and appropriateness for all levels of care as required by group contract.

3. Consult with physician, providers, members, and other resources, as appropriate, to assess, plan, facilitate implementation, coordinate, monitor, and evaluate options and services required to meet an individual's health needs, using communication and available resources to promote quality, cost effective outcomes.

4. Develop alternate plans and assist members/providers to navigate the health care system optimizing benefits. Refer care options to network providers.

5. Perform discharge care coordination, episodic case management and pre-admission/post discharge counseling and identification of alternate treatment options. Consult with physicians, coordinators, and facility discharge planners to determine other resources and appropriate disposition of such cases. Provide education, counseling and referral to other resources to minimize re-admissions and emergency room episodes.

6. Perform additional ongoing functions to support the member in the transition of care process including consulting with physicians, providers, members, and other resources, as appropriate, to assess, plan, facilitate implementation, coordinate, monitor and evaluate options and services required to meet an individual's acute health needs, using communication and available resources to promote quality health outcomes.

7. Contact high risk members and attempt to engage them in a condition specific education program based on condition specific National Standards of Care. Educate members regarding wellness and specific conditions based on National Standards of Care.

8. Provide supplemental educational materials to member as required.

9. Utilize Motivational Interviewing and Teleselling skills.

10. Collaborate with the Medical Directors, as necessary.

11. Maintain licensure and maintain and enhance knowledge for designated area of licensure and regulatory standards by attending seminars, training sessions, etc.

12. Practice within the scope of licensure in accordance with URAC and NCQA accreditation standards and with the applicable state Nurse Practice Act.

13. Communicate and interact effectively and professionally with co-workers, management, customers, etc.

14. Comply with HIPPA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.

15. Maintain complete confidentiality of company business.

16. Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects are required or requested.

JOB REQUIREMENTS:

* Registered Nurse (RN) with current, valid, unrestricted license in state of operations
* 2 years clinical practice experience of direct clinical care to the customer
* 1 year experience in Condition Management or Case Management in a health insurance/managed care setting
* PC proficiency to include Word, Excel, Lotus Notes and database experience
* Clear and concise verbal and written communication skills
* Knowledge of UM/CM/DM activities and standardized criteria set
* Familiarity of ancillary services including HHC, SNF, Hospice, etc
* Verbal and written communication skills; analytical skills; sound clinical judgment
* Incumbents with nursing licenses in positions/departments requiring multi-state licenses are required to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management. Multi-state license fees will be provided by HCSC. Incumbents with other clinical licenses are not required to obtain multi-state licenses.

PREFERRED JOB REQUIREMENTS:

* Experience in managing complex or catastrophic health cases
* Specialty clinical experience in intensive care medicine, orthopedic, NICU/pediatric, oncology, diabetic member management, obstetric (low to high risk maternity management)
* Working toward or completion of CCM/CCP/CDE certification or Advanced degree
* Knowledge of Milliman Guidelines or similar clinical guidelines
* Knowledge of medical management policies and procedures

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

HCSC Employment Statement:

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.