Medical Claims Review Manager jobs in Evansville, IN

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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Case Management Specialist - Utilization Review
  • Utilization Review in Owensboro, KY - Owensboro
  • Owensboro, KY FULL_TIME
  • Summary

    Job Summary

    Facilitates cost-effective, quality patient outcomes by determining the appropriate level of care and providing guidance, education, and support to assigned patients.
     
    Job Responsibilities
    • Assessment of complete chart and knowledge of patient's medical condition, financial status, emotional needs, and support systems.
    • Conducts initial and concurrent reviews of clinical documentation for medical necessity and appropriate level of care using approved criteria within specified time frame.
    • Provides appropriate clinical information to payers as requested within specified time frame.
    • Collaborates with the Physician, Medical Director, Director, Manager, and Supervisor of Case Management on patients who are not meeting the regulatory requirements for hospitalization.
    • Delivers regulatory letters to patients as needed.
    • Provides education and acts as a resource for physicians, staff, and patients/families regarding utilization review processes.
    • Trains new case managers, students, and interns as needed.
    Qualifications
    • Associate's degree or higher in Nursing required upon hire AND
    • Bachelor's degree or higher in Nursing required within 5 years of employment in this position
    • No experience required
    • RN - Licensed as a Registered Nurse. Eligible to practice nursing in the State of Kentucky required upon hire
    Skills and Attributes
    • Requires critical thinking skills and decisive judgment.
    • Works under minimal supervision.
    • Must be able to work in a stressful environment and take appropriate action.
    Physical Demands
    • Standing: Occasionally
    • Walking: Occasionally
    • Sitting: Frequently
    • Lifting 0-25 lbs: Rarely
    • Lifting 25-75 lbs: Never
    • Lifting over 75 lbs: Never
    • Carrying 0-25 lbs: Rarely
    • Carrying 25-75 lbs: Never
    • Carrying over 75 lbs: Never
    • Pushing/Pulling 0-25 lbs: Rarely
    • Pushing/Pulling 25-75 lbs: Never
    • Pushing/Pulling over 75 lbs: Never
    • Climbing: Rarely
    • Bending/Stooping: Rarely
    • Kneeling: Rarely
    • Crouching/Crawling: Rarely
    • Reaching: Occasionally
    • Talking: Frequently
    • Hearing: Occasionally
    • Repetitive Foot/Leg Movements: Never
    • Repetitive Hand/Arm Movements: Frequently
    • Keyboard Data Entry: Frequently
    • Running: Never
    • Vision: Depth Perception: Frequently
    • Vision: Distinguish Color: Frequently
    • Vision: Seeing Far: Frequently
    • Vision: Seeing Near: Frequently
    Owensboro Health Core Commitments

    INTEGRITY - We conduct ourselves with a high level of responsibility, reliability and honesty because we take seriously the trust of our patients and coworkers.

    RESPECT - We value and accept the unique talents and contributions of every patient, customer and team member in the Owensboro Health community.

    TEAMWORK - We build a spirit of connectivity and fellowship by striving together to overcome obstacles, surpass goals, celebrate accomplishments and plan the future.

    INNOVATION - We foster original ideas and creative solutions that improve our daily work and promote the mission of Owensboro Health.

    SERVICE - We focus on service to patients, customers and team members by anticipating their needs, thoughtfully meeting those needs and continually improving the quality of everything we do.

    EXCELLENCE - We reach beyond basic expectations to expand our knowledge and awareness, produce exceptional work and provide outstanding service.
  • 30 Days Ago

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Network Firewall Review Analyst
  • Intone Networks
  • Evansville, IN FULL_TIME
  • Responsibilities: Must perform duties with a self-starting demeanor. Conduct duties and behaviors with a cybersecurity-centric mindset. Document well-analyzed implementation and reversion plans for al...
  • 4 Days Ago

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Contract Review Specialist
  • Mpd Inc
  • Owensboro, KY FULL_TIME
  • MPD Components, Inc. traces its roots back over 100 years to the very beginning of electric power and the electronic age. MPD products can be found in most aircraft, on-board spacecraft, on ships at s...
  • 1 Month Ago

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Operations Manager
  • MedicOne Medical Response
  • Marion, IL FULL_TIME
  • MedicOne Medical Response is a leader in pre-hospital medicine and healthcare transportation system design and operations. Since 1999, we've grown from 2 ambulances and 8 employees to a fleet of 100 v...
  • 2 Months Ago

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Paid Product Tester
  • Product Review Jobs
  • OLATON, KY 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...
  • 22 Days Ago

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Paid Product Tester
  • Product Review Jobs
  • MILL SHOALS, IL 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...
  • 22 Days Ago

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0 Medical Claims Review Manager jobs found in Evansville, IN area

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Remote Licensed Psychiatrist
  • Headway
  • Evansville, IN
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/15/2024 12:00:00 AM

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Remote Licensed Psychiatric Nurse Practitioner
  • Headway
  • Evansville, IN
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/15/2024 12:00:00 AM

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Remote Licensed Professional Counselor
  • Headway
  • Evansville, IN
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/15/2024 12:00:00 AM

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Remote Licensed Psychiatric Nurse Practitioner
  • Headway
  • Evansville, IN
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/15/2024 12:00:00 AM

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Remote Licensed Mental Health Counselor
  • Headway
  • Evansville, IN
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/15/2024 12:00:00 AM

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Remote Licensed Psychiatrist
  • Headway
  • Evansville, IN
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/15/2024 12:00:00 AM

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Remote Licensed Marriage and Family Therapist
  • Headway
  • Evansville, IN
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/15/2024 12:00:00 AM

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Remote Licensed Mental Health Therapist
  • Headway
  • Evansville, IN
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/15/2024 12:00:00 AM

Evansville is a city and the county seat of Vanderburgh County, Indiana, United States. The population was 117,429 at the 2010 census, making it the state's third-most populous city after Indianapolis and Fort Wayne, the largest city in Southern Indiana, and the 232nd-most populous city in the United States. It is the commercial, medical, and cultural hub of Southwestern Indiana and the Illinois-Indiana-Kentucky tri-state area, home to over 911,000 people. The 38th parallel crosses the north side of the city and is marked on Interstate 69. Situated on an oxbow in the Ohio River, the city is of...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$92,498 to $117,936
Evansville, Indiana 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