Case Manager

Overview

Aquent has an exciting opportunity for a Case Manager in the United States!

This position is 100% remote.  We will only consider candidates who currently live in the United States.  Out-of-country applicants will not be considered.

In addition, to be considered for this position, you must:

• Be authorized to work in the United States
• Not require sponsorship of any kind for the duration of the assignment
• Be able to work on a W-2 basis.  C2C or 1099 is not permitted for this position
• Be able to pass a background check and drug screen

Are you ready to make a tangible difference in people’s lives by ensuring their voices are heard and their concerns are expertly addressed? As a vital part of a leading organization committed to delivering exceptional health services, you will step into a role where your meticulous attention to detail, empathetic communication, and problem-solving prowess directly contribute to a superior experience for individuals navigating their healthcare journey. Partnering with Aquent, you will join a team dedicated to upholding the highest standards of compliance and member satisfaction, making a profound impact on the organization’s mission to serve its community.

We are seeking a proactive and compassionate individual to join our team, focusing on the critical process of managing complaints and grievances. In this role, you will be at the forefront of ensuring fairness, transparency, and resolution for individuals, acting as a key liaison between them and the organization. Your work will directly enhance trust and satisfaction, contributing to the overall success and reputation of a respected service provider.

Responsibilities:

• Manage and participate in the organization’s complaint and grievance process from start to finish.
• Conduct thorough investigations into all issues, meticulously collecting and documenting relevant data.
• Identify and handle specialized or flagged cases, ensuring adherence to appropriate protocols.
• Engage with a diverse range of internal and external stakeholders to achieve outstanding outcomes in complaint and grievance resolution, compliance, and documentation.
• Collaborate with internal staff, managers, and medical professionals to swiftly resolve complex issues.
• Research, resolve, and clearly communicate decisions regarding complaints and grievances to individuals or their authorized representatives.
• Guarantee that all processes align with federal and state regulations, compliance standards, and internal policies.
• Efficiently manage your workload to meet performance deadlines while maintaining the highest quality for sensitive and complex issues.
• Maintain the integrity of the departmental database through accurate and timely data entry, consistent with regulatory requirements.
• Actively participate in departmental meetings, training sessions, and audits.
• Provide support and manage inquiries for existing and open cases.
• Escalate critical issues to management as needed to ensure continuous compliance.

Qualifications:

• High School Diploma or GED required.
• Proven experience in a service-related industry; call center experience is a plus.
• Exceptional interpersonal, verbal, and written communication skills.
• Demonstrated ability to collaborate effectively with peers in self-managed teams.
• Strong organizational skills with the ability to prioritize tasks and ensure all compliance elements are met.
• Excellent conflict resolution and mediation skills, capable of securing action from multiple stakeholders.
• Ability to exercise sound judgment and manage complex issues independently, knowing when to escalate and seek support.
• Demonstrated ability to thrive in a time-sensitive environment involving individuals, family members, and advocates.
• Extensive working knowledge of personal computers, including Windows-based software applications and MS Word.
• Capacity to multitask and manage time effectively, balancing long-term projects with short-term demands.
• Ability to work collaboratively and effectively in a dynamic, multi-stakeholder environment.

Nice-to-Have Qualifications:

• Some college education preferred.
• Experience within a complex healthcare environment.
• Strong working knowledge of federal and state regulations, laws, and accreditation standards pertinent to healthcare and managed care organizations.
• Familiarity with member complaint and grievance processing.
• Competent working knowledge of health plan benefits, plans, contracts, and systems.

The target hiring compensation range for this role is $26.54 to $29.49 an hour. Compensation is based on several factors including, but not limited to education, relevant work experience, relevant certifications, and location.

About Aquent Talent:
Aquent Talent connects the best talent in marketing, creative, and design with the world’s biggest brands.
Our eligible talent get access to amazing benefits like subsidized health, vision, and dental plans, paid sick leave, and retirement plans with a match. More information on our awesome benefits!
Aquent is an equal-opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics. We’re about creating an inclusive environment—one where different backgrounds, experiences, and perspectives are valued, and everyone can contribute, grow their careers, and thrive.

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