Medical Claims Review Manager jobs in Macon, GA

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

  • 21 Days Ago

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Plan Review
  • Macon Water Authority
  • Macon, GA OTHER
  • Job Summary: Reviews and evaluates Water, Sewer and Erosion, Sedimentation, and Pollution Control (ESPC) plans. The reviewer prepares easement drawings and documents. This role assists in obtaining ea...
  • 2 Months Ago

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Nurse Manager
  • Houston Medical Center
  • Warner Robins, GA FULL_TIME
  • Outpatient Surgery Full Time · 8:00am - 4:30pm EVERY OTHER WEEKEND OTHER SHIFTS AS NEEDED · Call typically not required NE20 Responsible for maintaining and effective and organized unit which provides...
  • 6 Days Ago

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Coding Manager
  • Houston Medical Center
  • Warner Robins, GA FULL_TIME
  • Medical Coding Full Time · 8:00a - 4:30p · Call typically not required M3 Position Summary: Monitors coding quality and productivity levels according to established standards. Reviews coding queries f...
  • 20 Days Ago

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Medical Practice Manager
  • Aylo Health
  • Jackson, GA FULL_TIME
  • At Aylo Health, we work together to enrich the health and well-being of every life we touch. Our mission is to make quality healthcare simple and convenient. Because healthy people can do amazing thin...
  • 3 Days Ago

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Food & Nutrition Services Manager
  • Houston Medical Center
  • Warner Robins, GA FULL_TIME
  • Food & Nutritional Services Full Time · 5:30a-6p · Required to take call MNE1 Performs a wide variety of duties in the daily management/supervision of the department including coordinating all activit...
  • 21 Days Ago

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0 Medical Claims Review Manager jobs found in Macon, GA area

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Remote Licensed Clinical Social Worker
  • Headway
  • Macon, GA
  • Remote Licensed Clinical Social Worker (LCSW) Wage: Between $89-$122 an hour Are you a Licensed Clinical Social Worker l...
  • 5/6/2024 12:00:00 AM

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Remote Licensed Professional Counselor
  • Headway
  • Macon, GA
  • Remote Licensed Professional Counselor (LPC) Wage: Between $89-$122 an hour Are you a Licensed Professional Counselor lo...
  • 5/6/2024 12:00:00 AM

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Remote Licensed Marriage and Family Therapist
  • Headway
  • Macon, GA
  • Remote Licensed Marriage and Family Therapist (LMFT) Wage: Between $89-$122 an hour Are you a Licensed Marriage and Fami...
  • 5/6/2024 12:00:00 AM

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Remote Licensed Mental Health Counselor
  • Headway
  • Macon, GA
  • Remote Licensed Mental Health Counselor (LMHC) Wage: Between $89-$122 an hour Are you a Licensed Mental Health Counselor...
  • 5/6/2024 12:00:00 AM

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Remote Licensed Clinical Psychologist
  • Headway
  • Macon, GA
  • Remote Licensed Clinical Psychologist Wage: Between $89-$196 an hour Are you a Licensed Clinical Psychologist looking to...
  • 5/6/2024 12:00:00 AM

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Remote Licensed Psychiatrist
  • Headway
  • Macon, GA
  • Remote Licensed Psychiatrist Wage: Between $106 - $261 an hour Are you a licensed Psychiatrist looking to launch a priva...
  • 5/6/2024 12:00:00 AM

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Remote Licensed Psychiatric Nurse Practitioner
  • Headway
  • Macon, GA
  • Remote Licensed Psychiatric Nurse Practitioner Wage: Between $126-$220 an hour Are you a licensed Psychiatric Nurse look...
  • 5/6/2024 12:00:00 AM

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Remote Licensed Mental Health Therapist
  • Headway
  • Macon, GA
  • Remote Licensed Mental Health Therapist (LMHT) Wage: Between $89-$122 an hour Are you a Licensed Mental Health Therapist...
  • 5/6/2024 12:00:00 AM

Macon (/ˈmeɪkən/), officially Macon–Bibb County, is a consolidated city-county located in the state of Georgia, United States. Macon lies near the geographic center of the state, approximately 85 miles (137 km) south of Atlanta, hence the city's nickname "The Heart of Georgia." Located near the fall line of the Ocmulgee River, Macon is the county seat of Bibb County and had a 2017 estimated population of 152,663. Macon is the principal city of the Macon metropolitan area, which had an estimated population of 228,914 in 2017. Macon is also the largest city in the Macon–Warner Robins Combined St...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$87,923 to $112,102
Macon, Georgia area prices
were up 1.5% 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