Medical Claims Review Manager jobs in Newark, NJ

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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Physician Spine Surgeon Telecommute Medical Review
  • Concentra
  • Newark, NJ OTHER
  • Overview

    Are you an accomplished Board Certified Spine Surgeon? Are you passionate about your work/life balance? We are seeking flexible and experienced physicians for our medical reviewstream division. This telecommute role provides the ability for you to customize your schedule and caseload within a Monday - Friday work week and within business hours.  Create a flexible work schedule and be compensated on a per case basis as a 1099 independent contractor.  

     

    JOB SUMMARY: Relying on clinical background, reviews health claims providing medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with Concentra Physician Review policies, procedures, and performance standards and URAAC guidelines and state regulations.

    Responsibilities

    MAJOR DUTIES AND RESPONSIBILITIES:

    • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and Medical Leave Act (FMLA), Group health and workers’ compensation claims. • Meets (when required) with Concentra Physician Review Medical Director to discuss quality of care and credentialing and state licensure issues.• Maintain proper credentialing and state licenses and any special certifications or requirements necessary to perform the job.• Returns cases in a timely manner with clear concise and complete rationales and documented criteria. • Telephonically contacts providers and interacts with other health professionals in a professional manner. Discusses the appropriate disclaimers and appeal process with the providers.• Attends orientation and training• Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.• Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer reviewed literature that support sound and objective decision making and rationales in reviews.• Provides copies of any criteria utilized in a review to a requesting provider in a timely manner

     

    Qualifications

    EDUCATION/CREDENTIALS:

    -Board certified MD, DO, with an excellent understanding of network services and managed care, appropriate utilization of services and credentialing, quality assurance and the development of policies that support these services. -Current, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer. -Must be in active medical practice to perform appeals JOB-RELATED EXPERIENCE:Post-graduate experience in direct patient careJOB-RELATED SKILLS/COMPETENCIES: -Demonstrated computer skills, telephonic skills-Demonstrated ability to perform review services.-Ability to work with various professionals including members of regulatory agencies, carriers, employers, nurses and health care professionals. -Medical direction shall also be provided consistent with the requirement that the physician advisor shall not have a financial conflict of interest -Must present evidence of current error and omissions liability coverage for job duties and activities performed-Managed care orientation-Knowledge of current practice standards in specialty-Good negotiation and communication skillsWORKING CONDITIONS/PHYSICAL DEMANDS: -Phone accessability -Access to a computer to complete reviews-Ability to complete cases accompanied by a typed report in specified time frames-Telephonic conferences

    This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.

     

    Concentra is an Equal Opportunity Employer M/F/Disability/Veteran

     

    Concentra's Data Protection Commitment*    Concentra is committed to protect patient data and to ensure privacy of personal and medical information.*    Every Concentra colleague has the responsibility to adhere to data protection principles.*    If a colleague's role includes handling or processing sensitive data, role-specific policies and requirements apply to ensure the protection of patient information.

    Additional Data

    This position is an independent contractor role for Concentra.

     

    Select Medical is committed to having a workforce that reflects diversity at all levels and is an equal opportunity employer. Qualified applicants are considered for employment, and employees are treated during employment without regard to race, color, religion, national origin, citizenship, age, sex, sexual orientation, gender identity, marital status, ancestry, physical or mental disability, veteran status, or any other characteristic protected under applicable law.

  • 15 Days Ago

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Analyst, Revenue Enablement
  • Claims Solutions
  • Jersey, NJ FULL_TIME
  • Company Description We help the world see new possibilities and inspire change for better tomorrows. Our analytic solutions bridge content, data, and analytics to help business, people, and society be...
  • 5 Days Ago

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Manager, Contracts and Claims
  • NJ Transit
  • Newark, NJ FULL_TIME
  • Move forward with us! At NJ TRANSIT, you'll join us in transforming the third-largest transportation agency in North America. We are committed to delivering safe, reliable service that gets customers ...
  • 13 Days Ago

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General Liability Adjuster
  • TheBest Claims Solutions
  • Newark, NJ FULL_TIME
  • General Liability Adjuster NEWARK, NJ 07396 | TEMPORARY $40.00 TO $50.00 PER HOUR, DEPENDING ON EXPERIENCE Job Description Our client, a National Carrier is looking for a General Liability Claims Adju...
  • 23 Days Ago

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Forensic Electrical Engineer, P.E.
  • Sedgwick Claims Management Services Inc.
  • Newark, NJ FULL_TIME
  • The 'Apply with SEEK option' will be utilized for International applicants, mainly Australia. If this does not apply to you please use the 'Apply' option. IF YOU CARE, THERE’S A PLACE FOR YOU HERE EFI...
  • 24 Days Ago

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Claims Operations Manager - Surety (Morristown, NJ or Remote)
  • Crum & Forster
  • Morristown, NJ FULL_TIME
  • Crum & Forster Company Overview: Crum & Forster (C&F) Crum & Forster (C&F), with a proud history dating to 1822, provides specialty and standard commercial lines insurance products through our admitte...
  • 10 Days Ago

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0 Medical Claims Review Manager jobs found in Newark, NJ area

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Medical Assistant
  • Tru Medical Management
  • New York, NY
  • Job Description Job Description We are looking for a skilled and organized medical assistant to join our healthcare team...
  • 3/29/2024 12:00:00 AM

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Remote Licensed Professional Counselor
  • Headway
  • Jersey City, NJ
  • Remote Licensed Professional Counselor (LPC) Wage: Between $120-$131 an hour Are you a Licensed Professional Counselor l...
  • 3/28/2024 12:00:00 AM

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Residential Counselor - Community Support Services (CSS)
  • SERV Behavioral Health System
  • Harrison, NJ
  • A currently competent, bachelor level professional who delivers behavioral health care services to residing in the commu...
  • 3/28/2024 12:00:00 AM

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Remote Licensed Clinical Social Worker
  • Headway
  • Jersey City, NJ
  • Remote Licensed Clinical Social Worker (LCSW) Wage: Between $120-$131 an hour Are you a Licensed Clinical Social Worker ...
  • 3/28/2024 12:00:00 AM

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Remote Licensed Clinical Psychologist
  • Headway
  • Jersey City, NJ
  • Remote Licensed Clinical Psychologist Wage: Between $166-$196 an hour Are you a Licensed Clinical Psychologist looking t...
  • 3/28/2024 12:00:00 AM

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Remote Licensed Mental Health Counselor
  • Headway
  • Jersey City, NJ
  • Remote Licensed Mental Health Counselor (LMHC) Wage: Between $120-$131 an hour Are you a Licensed Mental Health Counselo...
  • 3/28/2024 12:00:00 AM

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Medical Receptionist
  • Tru Medical Management
  • New York, NY
  • Job Description Job Description Job description We are looking for a skilled and organized medical receptionist to join ...
  • 3/27/2024 12:00:00 AM

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Center Director
  • The Learning Experience
  • Newark, NJ
  • Benefits: 401(k) Competitive salary Paid time off Center Directors at The Learning Experience influence the growth and d...
  • 3/25/2024 12:00:00 AM

Newark (/ˈnjuːərk/,[24] locally /njʊərk/)[25] is the most populous city in the U.S. state of New Jersey and the seat of Essex County.[26] As one of the nation's major air, shipping, and rail hubs, the city had a population of 285,154 in 2017, making it the nation's 70th-most populous municipality, after being ranked 63rd in the nation in 2000. Settled in 1666 by Puritans from New Haven Colony, Newark is one of the oldest cities in the United States. Its location at the mouth of the Passaic River (where it flows into Newark Bay) has made the city's waterfront an integral part of the Port of New...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$110,203 to $140,510
Newark, New Jersey area prices
were up 1.6% 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