Medical Claims Review Manager jobs in Seattle, WA

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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Medical Staff Review Coordinator - RN
  • UW Medicine/Valley Medical Center
  • Renton, WA FULL_TIME
  • Job Description
    Outcomes Management

    The position description is a guide to the critical duties and essential functions of the job, not an all-inclusive list of responsibilities, qualifications, physical demands and work environment conditions. Position descriptions are reviewed and revised to meet the changing needs of the organization.
    TITLE: Medical Staff Review Coordinator

    JOB OVERVIEW: Responsible for supporting and facilitating ongoing organization-wide and medical staff quality management, patient safety and performance improvement programs and activities.

    DEPARTMENT: Outcomes Management

    WORK HOURS: Typically, Monday - Friday 8:00am - 4:30pm. Some flexibility may be required to meet department and organization needs.

    RESPONSIBLE TO: Director, Quality & Patient Safety

    PREREQUISITES:
    Bachelor's degree in nursing or other health care related field of study; Master's degree preferred
    Minimum five year's recent experience in acute health care setting - particularly in Critical Care or medical/surgical nursing
    Experience in quality improvement role preferred
    Experience in Process Improvement Models - e.g. IHI Model for Improvement, Deming principles, Lean, PDCA, Six Sigma, etc. preferred
    CPHQ preferred

    QUALIFICATIONS:
    Solid understanding of systems thinking, process management and performance improvement.
    Organizational and problem-solving ability and skills.
    Knowledge of group process, leadership skills, and ability to establish and maintain respectful, collaborative and effective working relationships with medical staff.
    Proficiency in application of change management principles.
    Ability to prepare effective oral and written reports and presentations to various groups including providers, hospital leaders and staff.
    Proficiency in use of Windows® and MS Office Suites® applications particularly Word, PowerPoint and Excel.
    Aptitude for navigating quality-related Internet sites and support agencies.
    Ability to focus significant periods of time on abstraction of information from medical records and facilitate use of a database.

    UNIQUE PHYSICAL/MENTAL DEMANDS, ENVIRONMENT AND WORKING CONDITIONS:
    See Generic Job Description for Administrative Partner.

    PERFORMANCE RESPONSIBILITIES:
    A. Generic Job Functions: See Generic Job Description for Administrative Partner.
    B. Essential Responsibilities and Competencies
    Collaborate with Medical Director of Medical Staff Services to support and participate actively on Medical Staff Peer Review committees including:
    Scheduling committee meeting
    Planning of agenda
    Screening and disseminating case reviews to members
    Facilitating measurement system management, including collecting, analyzing and presenting rates/rules and other information for evaluation of practitioner performance
    Completing minutes as required
    Facilitating committee processes, to support timely and unbiased reviews
    Facilitating follow-up as indicated, such as coordinating distribution of letters to medical staff and tracking of case reviews
    Familiarity with Medical Staff bylaws, policies and procedures
    Coordinate and produce accurate, complete and timely reports as scheduled or requested
    Identify and report variations in clinical care that require immediate action
    Function as a resource to explain the structure and process for assessing, maintaining, and distributing information on practitioner performance review
    Function as a resource to physicians in the analysis, interpretation and use of data for decision-making and performance improvement
    Utilize internal and external comparative data sources to identify improvement opportunities
    Apply current literature and knowledge of best practices to develop improvement strategies
    Support collection, analyses and interpretation from multiple data sources for ongoing quality management activities of the medical staff
    Produce an annual summary report of reviewed medical staff cases by individual practitioner for committee review indicators. (e.g., complications, readmissions, safety events, mortalities)
    Actively participate in program structure to develop measure criteria and benchmarks to support consumable reports for practitioner review
    Collect, analyze and interpret data and information to support decision-making toward performance improvement, including periodic OPPE reports to be provided to the Chief Medical Officer, department chairs, and the MSO for inclusion in the practitioner's quality file
    Collaborate with data analysts, QI Specialists, Patient Safety Specialists, Risk Management and Regulatory teams
    Support the organization during TJC and DOH visits as a navigator or scribe
    Network with peers at other organizations within the local community; participate on UWMedicine work groups related to role, in order to advance best practices within specialty
    Maintain confidentiality of individual patient and medical staff information
    Perform other duties as assigned to meet patient/program needs including participation in orientation of new staff.

    Revised: 3/21
    Grade: NCNM28
    FLSA: E
    CC: 8715

    PREREQUISITES:
    Bachelor's degree in nursing or other health care related field of study; Master's degree preferred
    Minimum five year's recent experience in acute health care setting - particularly in Critical Care or medical/surgical nursing
    Experience in quality improvement role preferred
    Experience in Process Improvement Models - e.g. IHI Model for Improvement, Deming principles, Lean, PDCA, Six Sigma, etc. preferred
    CPHQ preferred

    QUALIFICATIONS:
    Solid understanding of systems thinking, process management and performance improvement.
    Organizational and problem-solving ability and skills.
    Knowledge of group process, leadership skills, and ability to establish and maintain respectful, collaborative and effective working relationships with medical staff.
    Proficiency in application of change management principles.
    Ability to prepare effective oral and written reports and presentations to various groups including providers, hospital leaders and staff.
    Proficiency in use of Windows® and MS Office Suites® applications particularly Word, PowerPoint and Excel.
    Aptitude for navigating quality-related Internet sites and support agencies.
    Ability to focus significant periods of time on abstraction of information from medical records and facilitate use of a database.
  • 14 Days Ago

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Field Case Manager
  • Sedgwick Claims Management Services Inc.
  • Seattle, WA FULL_TIME
  • Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flex...
  • 26 Days Ago

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Senior Claims Insurance Manager - Medical Professional Liability Claims *Remote
  • Providence Health
  • Renton, WA FULL_TIME
  • Description Providence caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutu...
  • 1 Month Ago

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Senior Development Review Manager
  • City of Sammamish
  • Sammamish, WA FULL_TIME
  • Oversees and manages engineering development review and construction services for the city to ensure development proposals are compliant with engineering standards and codes, particularly for stormwat...
  • 1 Day Ago

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Medical Staff Peer Review Coordinator
  • University of Washington (UW) Medicine
  • Renton, WA OTHER
  • Job DetailJob Title:Medical Staff Peer Review CoordinatorReq:2023-0313Location:Department:Outcomes ManagementShift:Type:OC / PDFTE:0Hours:City State:Renton, WASalary Range:Min $88,168 - $140,185/annua...
  • 1 Month Ago

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Senior Workers Compensation Claims Adjuster
  • TheBest Claims Solutions
  • Seattle, WA TEMPORARY
  • Senior Workers Compensation Claims Adjuster SEATTLE, WA 98039 | TEMPORARY $35.00 TO $40.00 PER HOUR, DEPENDING ON EXPERIENCE Job Description Our client, a national insurance company, is looking to add...
  • 7 Days Ago

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0 Medical Claims Review Manager jobs found in Seattle, WA area

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Psychiatric Nurse Practitioner_Contract California 100% REMOTE
  • Wellpsyche Medical Group
  • Seattle, WA
  • CA Licensure Required Remote Position! WellPsyche Medical Group is actively hiring for Psychiatric Nurse Practitioners! ...
  • 4/18/2024 12:00:00 AM

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Chief Strategy Officer (CSO)
  • Confidential
  • Seattle, WA
  • Chief Strategy Officer (CSO) About the Company Established organization assisting migrants with health insurance Industr...
  • 4/18/2024 12:00:00 AM

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Remote Licensed Alcohol and Drug Counselor (LADC-I) - Massachusetts
  • Headway
  • Seattle, WA
  • Are you a Licensed Alcohol and Drug Counselor (LADC-I) in Massachusetts in South Dakota looking to launch a private prac...
  • 4/18/2024 12:00:00 AM

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Remote Certified Substance Abuse Counselor (CSAC) - Hawaii
  • Headway
  • Seattle, WA
  • Are you a Certified Substance Abuse Counselor (CSAC) in Hawaii looking to launch a private practice, or grow your existi...
  • 4/18/2024 12:00:00 AM

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Psychiatric Mental Health Nurse Practitioner - Seattle, WA
  • LifeStance Health
  • Seattle, WA
  • At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make liv...
  • 4/16/2024 12:00:00 AM

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REMOTE Psychiatric Mental Health Nurse Practitioner (PMHNP)
  • Seasoned Recruitment
  • Seattle, WA
  • We are hiring for both full-time and part-time opportunities We are hiring Psychiatric Mental Health Nurse Practitioners...
  • 4/16/2024 12:00:00 AM

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Remote Licensed Psychiatrist
  • Headway
  • Seattle, WA
  • 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
  • Seattle, WA
  • 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

Seattle (/siˈætəl/ (listen) see-AT-əl) is a seaport city on the West Coast of the United States. It is the seat of King County, Washington. With an estimated 730,000 residents as of 2018[update], Seattle is the largest city in both the state of Washington and the Pacific Northwest region of North America. According to U.S. Census data released in 2018, the Seattle metropolitan area’s population stands at 3.87 million, and ranks as the 15th largest in the United States. In July 2013, it was the fastest-growing major city in the United States and remained in the Top 5 in May 2015 with an annual...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$107,622 to $137,219
Seattle, Washington area prices
were up 2.8% 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