Branch Review Team Lead jobs in Queens Village, NY
Branch Review Team Lead manages a group of review specialists. Plans, schedules, and directs internal audits of bank branches, and prepares findings reports. Being a Branch Review Team Lead tests established procedures to ensure operational efficiency within branch offices. Oversees branch reviews and evaluation. Additionally, Branch Review Team Lead may require a bachelor's degree. Typically reports to a manager or head of a unit/department. The Branch Review Team Lead supervises a small group of para-professional staff in an organization characterized by highly transactional or repetitive processes. Contributes to the development of processes and procedures. Thorough knowledge of functional area under supervision. To be a Branch Review Team Lead typically requires 3 years experience in the related area as an individual contributor. (Copyright 2024 Salary.com)
Recently Added Branch Review Team Lead jobs
Clinical Review Nurses
- Mitchell Martin
-
Fresh Meadows, NY
CONTRACTOR,FULL_TIME
-
A Day treatment facility located in Flushing, NY is looking for an Clinical Review Nurses.
Type: Contract
Schedule: M-F 8:30am-5:30pm -1 Hour Break, as well as two 15-minute breaks
Location: Flushing, NY
JOB PURPOSE:
The Clinical Review Nurse is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance standards.
Responsible for determining the medical appropriateness of inpatient and outpatient services by reviewing clinical information and applying evidence-based guidelines with state, federal, Managed Long-Term Care, and PACE regulations.
The Clinical Review Nurse will manage his/her own caseload and is accountable for investigating and resolving participant or provider-initiated appeal cases, including clinical claim appeals from participating and non-participating providers.
The position works closely with the Medical Director.
RESPONSIBILITIES:
Performs clinical/medical reviews of previously denied cases in which a formal appeals request has been made.
Interacts with clients providers, participants, and internal service & care delivery teams to obtain necessary information and communicating appeal determinations timely.
The Clinical Review Nurse works closely with the A&G Specialists to ensure accurate entry of a case for tracking purposes.
Works independently, prioritizes case deliverables, and stays current on changes in the healthcare system that may affect clinical decisions.
Excellent knowledge of all relevant PACE and applicable Federal and State regulatory requirements and guidelines, knowledge of policies and procedures, and individual judgment and experience to assess the appropriateness of services, items provided, length of stay and level of care.
Collects relevant medical information and applies the appropriate evidence-based guidelines and medical policy for denied services associated with appeal cases.
Follows documentation guidelines for clear and concise decision-making within EMR appeals tracking platform.
Maintains appeal cases in a complete, accurate, and organized fashion for audit readiness.
Collaborates with regional medical directors and upon direction, communicate appropriately with the regulator/team liaison.
Meets required decision-making timeframes, including promptly triggering escalation for cases requiring physician review.
Applies appropriate criteria on PAR and Non-PAR (contracted and non-contracted) provider claim appeal cases.
Reviews medically appropriate clinical guidelines and other appropriate criteria with Chief Medical Officer/ Medical Director on denial decisions.
The end- to-end process requires the Clinical Review Nurse to independently:
Research issues
Reference and understand CenterLight internal policies and procedures to frame decisions
Interpret PACE/CMS regulations
Resolve cases and make critical decisions
Update file documentation such as EMR, case notes and case summary
Manage all duties within regulatory timeframes
Prepares cases for Medical Director Review or External Physician Advisor ensuring that all pertinent information (i.e., case summary, contract information, internal and external responses, diagnosis, and CPT codes and descriptions) has been obtained during investigation and is presented in the Appeal Summary Review Sheet as part of the case
Prepares cases for Maximus Federal Services, Fair Hearing, and External Appeal through all levels of the appeal process.
Prepares and presents cases in conjunction with the Medical Director and IDT team for Administrative Law Judge pre-hearings meetings.
Represents and presents cases effectively to Judicial Fair Hearing Officer during Fair Hearings as may be required.
Serves as a clinical resource for Medical staff, IDT, and Participant/Provider Inquiries/Appeals.
Identifies and reports quality of care issues.
Communicates effectively to hand-off and pick-up work from colleagues as necessary.
Additional duties as assigned
QUALIFICATIONS:
Education: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred.
Licensure: Nursing
Experience:
3-5 years' clinical nursing experience, with 1-3 years in a managed care healthcare setting with experience clinical practice with experience in appeals & grievances or claims processing
Knowledgeable about Medicare (CMS) PACE and Medicaid MLTC regulations Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment
Other:
Requires excellent verbal and communications skills
Requires excellent organizational skills
Requires good PC skills and ability to manage applicable software. Ability to work independently on several computer applications such as Microsoft Word and Excel, as well as corporate email
Requires good interpersonal skills and the ability to work with all levels of employees
Please email: (url removed) - 9 Days Ago
Retail Team Lead - Elmhurst, NY
- Party City Holdings Inc.
-
Elmhurst, NY
FULL_TIME
- Job Description ARE YOU CUSTOMER OBSESSED? You are responsible for executing best in class sales and service strategies. Team Leads reinforce exceptional customer service behaviors delivered by the st...
- 25 Days Ago
Team Lead- Front of House/FULL TIME
- Chick-fil-A | Five Towns
-
Rosedale, NY
FULL_TIME
- Are you looking for work that positively influences those around you? Do you want to work for a company that is a part of customers’ lives and the communities it serves? Do you love working in a fast-...
- Just Posted
Team Lead- Back of House/FULL TIME
- Chick-fil-A | Five Towns
-
Rosedale, NY
FULL_TIME
- Are you looking for work that positively influences those around you? Do you want to work for a company that is a part of customers’ lives and the communities it serves? Do you love working in a fast-...
- 2 Days Ago
Team Lead- Back of House/FULL TIME
- Chick-fil-A | Five Towns
-
Rosedale, NY
FULL_TIME
- Are you looking for work that positively influences those around you? Do you want to work for a company that is a part of customers’ lives and the communities it serves? Do you love working in a fast-...
- 7 Days Ago
Branch Manager
- Restaurant Depot | Restaurant Depot
-
College Point, NY
FULL_TIME
- Position Title: Branch Manager Department: Management Supervisor:Regional Manager FLSA: Exempt Position Summary: Ensure efficient operation of the Branch to ensure customer satisfaction and projected ...
- 21 Days Ago
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0 Branch Review Team Lead jobs found in Queens Village, NY area
Branch Leader - Greenwich, CT
- Fidelity TalentSource LLC
-
Greenwich, CT
- Job Description: If you have a passion for doing what s right for the client and you want to work in a dynamic, client-f...
- 4/23/2024 12:00:00 AM
VP, Branch Leader - Chappaqua, NY
- Fidelity TalentSource LLC
-
Chappaqua, NY
- Job Description: It's said that the key to a successful sales strategy is to sell yourself, sell your company, and sell ...
- 4/23/2024 12:00:00 AM
Branch Leader - Flatiron, NY
- Fidelity TalentSource LLC
-
New York, NY
- Job Description: If you have a passion for doing what s right for the client and you want to work in a dynamic, client-f...
- 4/22/2024 12:00:00 AM
Branch Leader - Garden City, NY
- Fidelity TalentSource LLC
-
Garden City, NY
- Job Description: If you have a passion for doing what s right for the client and you want to work in a dynamic, client-f...
- 4/22/2024 12:00:00 AM
VP, Branch Leader - Wayne, NJ
- Fidelity TalentSource LLC
-
Wayne, NJ
- Job Description: It's said that the key to a successful sales strategy is to sell yourself, sell your company, and sell ...
- 4/22/2024 12:00:00 AM
Store Leader
- Go Go Curry America Group LLC
-
New York, NY
- Job Description Job Description Job description We are looking for a results driven retail store manager to be responsib...
- 4/21/2024 12:00:00 AM
Outlet Store Leader
- Bloomingdale's
-
Garden City, NY
- Job Description About: Bloomingdale's makes fashion personal and fun, aspirational yet approachable. Our mission is to g...
- 4/21/2024 12:00:00 AM
Assistant Store Leader - Joybird
- La-Z-Boy
-
New York, NY
- Joybird is the leading maker of handcrafted, custom-built furniture for the modern home and office. Through an innovativ...
- 4/21/2024 12:00:00 AM
About Queens Village, New York
Queens Village is a mostly residential middle class neighborhood in the eastern part of the New York City borough of Queens. The Queens Village Post Office serves the ZIP codes of 11427 (Hollis Hills and Bellaire), 11428 (central Queens Village), and 11429 (Southern Queens Village south of the LIRR Main Line). The neighborhood is part of Queens Community Board 13.
Shopping in the community is located along Braddock Avenue, Hillside Avenue, Hempstead Avenue, and Jamaica Avenue (NY 25), as well as on Springfield Boulevard. Located just east of Queens Village, in Nassau County, is the Belmont Par...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Branch Review Team Lead jobs
$91,109 to $144,595
Queens Village, New York area prices
were up 1.5% from a year ago
were up 1.5% from a year ago
What does a Branch Review Team Lead do?
Branch Review Team Lead in Newark, NJ
As a team lead, your job is slightly different from a branch review specialist.
December 29, 2019
Branch Review Team Lead in Springfield, MA
Specialists look to you as a team leader, someone who can guide them and keep them focused on important goals.
February 25, 2020
Branch Review Team Lead in Brockton, MA
You will exercise authority over other specialists, and will ensure things operate according to plan within the branch.
December 30, 2019