Medical Claims Review Manager jobs in Appleton, WI

Medical Claims Review Manager oversees the performance, productivity, and quality of the medical claims review staff. Responsible for hiring, training, and firing medical claims review staff. Being a Medical Claims Review Manager evaluates medical claims review processes and recommends process improvements. Serves as a technical resource for all medical review workers. Additionally, Medical Claims Review Manager typically requires an RN or BSN. Requires a bachelor's degree. Typically reports to a head of a unit/department. The Medical Claims Review Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Medical Claims Review Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)

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Medical Oncology Remote Chart Review Physicians
  • Max Populi, LLC
  • Milwaukee, WI FULL_TIME
  • 100% Remote opportunity to conduct utilization management - chart reviews for a brand name specialty benefits company. 

    We are seeking several physicians with a board certification in Medical Oncology/Hematology to support expansion needs for the Oncology specialty.

    - No long commutes to an office
    - flexible schedules including weekend hours available
    - part time or full time opportunities open
    - Work from the comfort of your home office
    -  Impact care within a growing MSK specialty
    -  All State licenses welcome
    - Must be proficient using Windows
    - Must be willing to train "on the job" 

    Minimum Requirements:               
    • The successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in a specialty recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18 months). 
    • Knowledge of applicable state and federal laws, URAC and NCQA standards a plus, and familiarity with automated processes and computer applications and systems is required
    Responsibilities:
    • Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.
    • Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.
    • Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.
    • Documents all actions related to clinical review sessions and attests to appeal review qualifications as required.
    • Maintains files of all reviews as required by law and Health Plans to retrieve reportable data.
    • Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications.
    • Supports the annual review of utilization review criteria.
    • Supports and communicates policy and procedures to the provider community.
    • Participates in strategic planning for and evaluation of the Care Management process/unit.
    • Assists with staff educational training and in-service programs and serves as a clinical resource for  staff.
    Our client  is committed to making a positive impact on healthcare, and also making a positive impact on our employees. This role offers a variety of perks and benefits including, but not limited to:
    • Flexible scheduling and work/life balance with remote and work from home opportunities
    • 4 weeks of PTO(starting) per year plus paid holidays
    • Education assistance, tuition reimbursement and professional certifications
    • Health, dental, vision, and life benefits with employer funded HSA
    • Comprehensive employee discount program, onsite fitness facilities, and smart casual dress code
    • Paid Volunteer Community Service Days
    • Ample opportunities for growth, advancement, and promotion
    • 401k retirement plan with company match of 50% employee contributions up to 6%  
     If interested, please send resume to skumar@maxpopuli.com or skumar@medpopuli.com.
  • 13 Days Ago

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Claims Associate - Workers Compensation / Medical-Only (Wausau, WI)
  • Sedgwick
  • Wausau, WI FULL_TIME
  • The 'Apply with SEEK' option will be utilized for International applicants, mainly Australia. Claims Associate - Workers Compensation / Medical-Only (Wausau, WI) IF YOU CARE, THERE’S A PLACE FOR YOU H...
  • 11 Days Ago

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Application Review Specialist
  • University of Wisconsin Oshkosh
  • Oshkosh, WI FULL_TIME
  • Official Title: Application Review Specialist Business Title: Admissions Application Processing and Review Specialist Employment Class: University Staff FTE: 1.0 Compensation: $15.00 - $17.00 FLSA Sta...
  • 16 Days Ago

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Paid Product Tester
  • Product Review Jobs
  • BRANTWOOD, WI FULL_TIME
  • Compensation: Varies per assignment. Up to $500 per week.Location: Remote (USA)Company: ProductReviewJobsThank you for your interest in becoming a Paid Product Tester. This opportunity is for completi...
  • 26 Days Ago

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Paid Product Tester
  • Product Review Jobs
  • Ogema, WI FULL_TIME
  • Compensation: Varies per assignment. Up to $500 per week.Location: Remote (USA)Company: ProductReviewJobsThank you for your interest in becoming a Paid Product Tester. This opportunity is for completi...
  • 26 Days Ago

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Paid Product Tester
  • Product Review Jobs
  • SCANDINAVIA, WI FULL_TIME
  • Compensation: Varies per assignment. Up to $500 per week.Location: Remote (USA)Company: ProductReviewJobsThank you for your interest in becoming a Paid Product Tester. This opportunity is for completi...
  • 26 Days Ago

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0 Medical Claims Review Manager jobs found in Appleton, WI area

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Remote Licensed Mental Health Counselor
  • Headway
  • Appleton, WI
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/23/2024 12:00:00 AM

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Remote Licensed Clinical Psychologist
  • Headway
  • Appleton, WI
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/20/2024 12:00:00 AM

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Remote Licensed Psychiatrist
  • Headway
  • Appleton, WI
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/20/2024 12:00:00 AM

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Remote Licensed Psychiatric Nurse Practitioner
  • Headway
  • Appleton, WI
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/20/2024 12:00:00 AM

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Remote Licensed Professional Counselor
  • Headway
  • Appleton, WI
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/20/2024 12:00:00 AM

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Remote Licensed Clinical Social Worker
  • Headway
  • Appleton, WI
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/20/2024 12:00:00 AM

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Remote Licensed Mental Health Therapist
  • Headway
  • Appleton, WI
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/20/2024 12:00:00 AM

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Remote Licensed Marriage and Family Therapist
  • Headway
  • Appleton, WI
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/19/2024 12:00:00 AM

Appleton is a city in Outagamie (mostly), Calumet, and Winnebago counties in the U.S. state of Wisconsin. One of the Fox Cities, it is situated on the Fox River, 30 miles (48 km) southwest of Green Bay and 100 miles (160 km) north of Milwaukee. Appleton is the county seat of Outagamie County. The population was 72,623 at the 2010 census. Of this, 60,045 were in Outagamie County, 11,088 in Calumet County, and 1,490 in Winnebago County. Appleton is the principal city of the Appleton, Wisconsin Metropolitan Statistical Area, which is included in the Appleton-Oshkosh-Neenah, Wisconsin Combined Sta...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$94,547 to $120,549
Appleton, Wisconsin area prices
were up 1.3% from a year ago

Medical Claims Review Manager in Paramus, NJ
Support management with leading Medical Review team to ensure all types of claims requiring medical reviews are completed in compliance with State, Federal, accreditation standards and other applicable regulations.
February 01, 2020
Medical Claims Review Manager in Nashua, NH
By truly combining claims and bill review, the two systems are kept in sync utilizing the scheduled jobs of the aforementioned standard model; however, for real-time data updates, claims examiners are granted access to the entire live bill review system.
January 13, 2020
Medical Claims Review Manager in Davenport, IA
Complex claim errors can only be caught by physician reviewers with the clinical experience to spot mistakes that automated systems can’t detect.
January 03, 2020