Medical Claims Review Manager jobs in Rockford, IL

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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Clinical Manager
  • Fresenius Medical Care
  • Janesville, WI FULL_TIME
  • About this role: As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations.  As the facility leader, you will be part of a close-knit, collaborative team responsible for delivering unique care plans and providing dialysis treatment to patients facing end stage renal disease or chronic kidney disease. 

    Training and advancement: You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning for our managers. The curriculum will cover onboarding, essential functions, leading your business, and advanced leadership.  As a Clinical Manager, you may advance your career into an Area Team Lead or Director of Operations role.

    Our culture: We believe our employees are our most important asset — we value, care about, and support our people. We are there when you may need us most, from tuition reimbursement to support your education goals, granting scholarships to family members, delivering relief when natural disasters strike, or providing financial support when personal hardship hits, we take care of our people.

    Our focus on diversity: We have built a nurturing environment that welcomes every age, race, gender, sexual orientation, background, and cultural tradition. We have a diverse range of employee resource groups (ERGs) to encourage employees with similar interests, goals, social and cultural backgrounds, or experiences to come together for professional and personal development, discussion, activities, and peer support. Our diverse workforce and culture encourage opportunity, equity, and inclusion for all, which is a tremendous asset that sets us apart.

    At Fresenius Medical Care, you will truly make a difference in the lives of people living with kidney disease. If this sounds like the career and company you have been looking for, and you want to be a vital part of the future of healthcare, apply today.

      

    PRINCIPAL RESPONSIBILITIES AND DUTIES

    CLINIC OPERATIONS:

    • Manages the operations of the clinic, including costs, processes, staffing, and quality standards.
    • Provides leadership, coaching, and development plans for all direct reports.
    • Partners with internal Human Resources, Quality, and Technical Services departments.
    • Collaborates with or functions as the Home Therapies Program Manager to oversee the facility’s Home Therapies Program.
    • Maintains integrity of medical and operations records and complies with all data collections and auditing activities.
    • Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding.
    • Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review.
    • Responsible for all required network reporting and on-site state or federal surveys.

    PATIENT CARE:

    • Coordinates all aspects of patient care with the appropriate staff members, from admission through discharge of the patient.
    • Ensure education of the patient regarding quality measures, transplant options, modality awareness, and access care.
    • Acts as a resource for the patient and family to address concerns and questions.
    • Accountable for timely completion of patient care assessments and care plans.
    • Manages timely patient schedules to ensure facility efficiency and develops action plans for missed treatments.
    • Plans, coordinates, and validates patient eligibility for treatment.
    • Reports changes in patient status regarding any clinical, insurance, or travel and transportation issues.  

    STAFF:

    • Participates in the selection and hiring of new team members and ensures completion of new hiring orientation and mandatory trainings.
    • Responsible for all patient care employees completing appropriate training courses and that licensures/certifications are current.
    • Provides support for all clinical staff members at regular intervals and encourages professional growth.
    • Maintains current knowledge regarding company benefits, policies, procedures, and processes.
    • Completes employee evaluations and establishes annual goals.
    • Documents any disciplinary actions and confers with the clinic Director of Operations and Human Resources when needed.
    • Manages staff scheduling and payroll.

    PHYSICIANS:

    • Facilitates the application process for physician privileges and compliance with Fresenius Medical Care Medical Staff By-Laws.
    • Responsible for strong physician relationships and ensures regular and effective communication.
    • Participates in Governing Body, an interdisciplinary team for each region including MSWs, Dietitians, MDs, DOs etc. that governs policies.

    EDUCATION AND REQUIRED CREDENTIALS:

    • Bachelor’s Degree or an equivalent combination of education and experience.
    • Graduate of an accredited School of Nursing (RN).
    • Current appropriate state licensure.

    EXPERIENCE AND SKILLS:  

    • Required:
      • 6 years business operations experience in a healthcare facility.
      • 12 months experience in clinical nursing.
      • 6 months chronic or acute dialysis nursing experience.
      • Successfully pass the Ishihara Color Blind Test.
    • Preferred but not required:
      • 3 years supervisory or project/program management experience.
      • Med/surg or ICU/CCU experience.

    PHYSICAL DEMANDS AND WORKING CONDITIONS:

    • Day-to-day work includes desk and personal computer work and interaction with patients, facility staff, and physicians
    • Position may require travel between assigned facilities and various locations within the community and/or travel to regional, business unit, and corporate meetings may be required.
    • The work environment is characteristic of a healthcare facility with air temperature control and moderate noise levels.
    • May be exposed to infectious and contagious diseases/materials.
    • Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 
    • The position provides direct patient care that regularly involves heavy lifting, moving of patients, and assisting with ambulation.  Equipment aids and/or coworkers may provide assistance. 

    EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity

    Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.

  • 4 Days Ago

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Paid Product Tester
  • Product Review Jobs
  • WOOSUNG, 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...
  • Just Posted

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Paid Product Tester
  • Product Review Jobs
  • WEDRON, 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...
  • Just Posted

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Paid Product Tester
  • Product Review Jobs
  • Eleroy, 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...
  • 1 Day Ago

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Paid Product Tester
  • Product Review Jobs
  • La Moille, 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...
  • 1 Day Ago

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Paid Product Tester
  • Product Review Jobs
  • Van, 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...
  • 1 Day Ago

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0 Medical Claims Review Manager jobs found in Rockford, IL area

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Remote Licensed Clinical Social Worker
  • Headway
  • Rockford, IL
  • 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 Psychiatrist
  • Headway
  • Rockford, IL
  • Remote Licensed Psychiatrist Wage: Between $232 - $269 an hour Are you a licensed Psychiatrist looking to launch a priva...
  • 3/28/2024 12:00:00 AM

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Remote Licensed Clinical Psychologist
  • Headway
  • Rockford, IL
  • 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 Marriage and Family Therapist
  • Headway
  • Rockford, IL
  • Remote Licensed Marriage and Family Therapist (LMFT) Wage: Between $120-$131 an hour Are you a Licensed Marriage and Fam...
  • 3/28/2024 12:00:00 AM

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Remote Licensed Professional Counselor
  • Headway
  • Rockford, IL
  • 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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Remote Licensed Psychiatric Nurse Practioner
  • Headway
  • Rockford, IL
  • Remote Licensed Psychiatric Nurse Practitioner Wage: Between $203 - $269 an hour Are you a licensed Psychiatric Nurse lo...
  • 3/28/2024 12:00:00 AM

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Remote Licensed Mental Health Therapist
  • Headway
  • Rockford, IL
  • Remote Licensed Mental Health Therapist (LMHT) Wage: Between $120-$131 an hour Are you a Licensed Mental Health Therapis...
  • 3/28/2024 12:00:00 AM

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Remote Licensed Mental Health Counselor
  • Headway
  • Rockford, IL
  • Remote Licensed Mental Health Counselor (LMHC) Wage: Between $120-$131 an hour Are you a Licensed Mental Health Counselo...
  • 3/27/2024 12:00:00 AM

Rockford is a city in Winnebago County in the U.S. state of Illinois, in far northern Illinois. Located on the banks of the Rock River, Rockford is the county seat of Winnebago County (a small portion of the city is located in Ogle County). The largest city in Illinois outside of the Chicago metropolitan area, Rockford is the third-largest city in the state and the 171st most populous in the United States According to 2010 U.S. Census Data, the City of Rockford had a population of 152,871, with an outlying metropolitan area population of 348,360. The City of Rockford's population is 147,051...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$95,873 to $122,239
Rockford, Illinois 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