Medical Claims Review Manager jobs in Georgia

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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Utilization Review - NRN
  • Houston Medical Center
  • Warner Robins, GA FULL_TIME
  • Care Management
    Full Time · 8:00a - 4:00p · Call typically not required
    H14
    The Non RN (NRN) Utilization Reviewer performs concurrent, extended stay and retrospective reviews of admissions using established criteria to determine appropriateness of admission and extended stay under direct supervision of a Registered Nurse. The NRN Utilization Reviewer refers questions from the medical and hospital staff on utilization and regulatory issues to the Director of Care Management or an RN Utilization
    Reviewer. The NRN Utilization Reviewer plays an integral role in discharge planning and maximizing the continuum of care for patients assigned to his/her assigned unit. The NRN Utilization Reviewer has the unique ability to follow the patient from admission to discharge and provide the physician and nursing staff with the best possible options for post hospital care for the patient.

    High School Graduate with over 5 years experience, and on the job training in records review, quality assurance chart review and training in the use of review criteria. LPN reviewers will be graduates of an approved school of practical nursing and maintain a current license to practice as an LPN in the state of Georgia. Minimum of five (5) years experience in a medical/hospital setting. Experience in Utilization Management, Quality Management, or related field preferred.

    Utilizes a variety of standard office equipment to include computer, printer, fax machine, copier, telephone etc. Basic knowledge of statistics encouraged. Ability to move throughout the hospital and possession of manual coordination and dexterity. Requires frequent sitting, standing and walking. Must be able to speak and have visual and hearing acuity. Pushes/pulls or moves/lifts office equipment and supplies. Works in a clean, well lighted heated and ventilated area. Flexibility with working hours; evening and weekend hours may be required. Must have interpersonal skills necessary to work productively with all levels of hospital personnel. Possess the mental acuity which enables the ability to make decisions. Must be able to utilize discretion in handling confidential information. Requires the ability to express self well both verbally and written. Must have excellent communication skills. Fiscal skills to monitor cost and revenue.

    Successful candidates will be subject to criminal background and drug screens.

    EOE/AA/Females/Minorities/Veterans/Disabled

  • 9 Days Ago

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Quality Review Manager
  • Examworks Group, Inc.
  • Lawrenceville, GA OTHER
  • Overview We are seeking passionate and skilled RN’s to serve as a Quality Review Manager, reviewing cases and ensuring all necessary information has been provided and is accurate before sending back t...
  • 24 Days Ago

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Quality Review Manager
  • ExamWorks, Inc.
  • Lawrenceville, GA FULL_TIME
  • Quality Review Manager Requisition ID 2024-10283 # of Openings 1 Category Operations Location US-GA-Lawrenceville Overview We are seeking passionate and skilled RN's to serve as a Quality Review Manag...
  • 25 Days Ago

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Manager - Claims
  • Inspire Brands
  • Atlanta, GA FULL_TIME
  • The Manager - Claims is responsible for implementing efficient claims management procedures and establishing protocols for successful claims resolution for all commercial insurance policies through de...
  • 20 Days Ago

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Claims Manager
  • Coalition, Inc.
  • Atlanta, GA FULL_TIME
  • About us Coalition is the world's first Active Insurance provider designed to help prevent digital risk before it strikes. Founded in 2017, Coalition combines broad insurance coverage with a digital r...
  • 11 Days Ago

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Medical Claims Specialist
  • SpotlightStaff.com
  • Rossville, GA FULL_TIME
  • Job Overview: We are seeking a detail-oriented and experienced Claims Specialist to join our team. As a Claims Specialist, you will be responsible for processing and managing medical claims in a timel...
  • 3 Days Ago

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Head of Medical Writing
  • Aerovate Therapeutics Inc.
  • Waltham, MA
  • Aerovate (AVTE) is a clinical stage biopharmaceutical company focused on developing drugs that meaningfully improve the ...
  • 4/26/2024 12:00:00 AM

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Veterinarian - Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Montclair, NJ
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 4/26/2024 12:00:00 AM

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Regional Medical Lead
  • HeartFlow, Inc
  • New York, NY
  • HeartFlow, Inc. is a medical technology company advancing the diagnosis and management of coronary artery disease, the #...
  • 4/26/2024 12:00:00 AM

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US Pneumococcal Adult Medical Lead, MD
  • Pfizer
  • New York, NY
  • ROLE SUMMARY Provide pneumococcal franchise leadership on behalf of Asset Medical Affairs team. * Collaborates with Bran...
  • 4/26/2024 12:00:00 AM

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Medical Director, Medical Management
  • Imperial Health Plan Of California Inc.
  • Pasadena, CA
  • People are the most important asset of Imperialfor this reason the difference and plurality of people, equality of oppor...
  • 4/26/2024 12:00:00 AM

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Head of Medical Writing
  • Aerovate Therapeutics, Inc.
  • Waltham, MA
  • Aerovate (AVTE) is a clinical stage biopharmaceutical company focused on developing drugs that meaningfully improve the ...
  • 4/25/2024 12:00:00 AM

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Assistant-Certified Medical Lead
  • Baptist Memorial
  • Memphis, TN
  • Summary Provides personal care assistance to patients under the direction of licensed personnel and /or Administrator. P...
  • 4/25/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco
  • Baldwin, NY
  • Create a healthier, brighter future for pets, pet parents and people!If you want to make a real difference, create an ex...
  • 4/23/2024 12:00:00 AM

Georgia is a state in the Southeastern United States.Beginning from the Atlantic Ocean, the state's eastern border with South Carolina runs up the Savannah River, northwest to its origin at the confluence of the Tugaloo and Seneca Rivers. It then continues up the Tugaloo (originally Tugalo) and into the Chattooga River, its most significant tributary. These bounds were decided in the 1797 Treaty of Beaufort, and tested in the U.S. Supreme Court in the two Georgia v. South Carolina cases in 1923 and 1989. The border then takes a sharp turn around the tip of Rabun County, at latitude 35°N, thou...
Source: Wikipedia (as of 04/17/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$94,352 to $120,300

Medical Claims Review Manager in Parkersburg, WV
This end-to-end e-billing and e-payment solution is fully integrated with DecisionPoint, which means it can be immediately and easily integrated with your providers, adjusters, IT infrastructure, and claims workflow—enabling you to.
January 01, 2020
Medical Claims Review Manager in Juneau, AK
Examples include a claims examiner’s view of a particular bill’s status in a claim record’s related bill screen, or a bill review analyst’s view of an available reserve amount for the claim record related to the bill they are processing.
December 03, 2019
Medical Claims Review Manager in Galveston, TX
Assists the Manager, Medical Review with performing duties to oversee day-to-day activities within the Medical Claims Review Department to facilitate the achievement of business goals and targets.
December 16, 2019