Medical Claims Review Manager jobs in Springfield, MO

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 Review Nurse
  • Vital Signs
  • Solo, MO FULL_TIME
  • 100% Remote, Work-From-Home position anywhere in the US. (Any state RN license is accepted).

    As an RN, you will provide direction, guidance, and support to our physician Medical Claims Reviewers as well as other staff as indicated. Complete quality audits of individual case reviews.

    Support the clinical aspects of the review process and case reviews, including but not limited to:

    • Support the reviewer selection and assignment process
    • Resolve operational issues arising in connection with the clinical aspects of review cases
    • Communicate with assigned reviewers and with treating/ordering practitioners/providers
    • Support the Case Fulfillment process and provide education to analysts as appropriate
    • Advise and provide guidance to reviewers on the operational aspects of review cases in all categories (i.e., standard, and ERO cases) and provide them with information pertinent to their assigned cases and related review processes
    • Collaborate with the Chief Medical Director and Director of Provider Relations to address reviewer quality issues; support the Provider Relations assessment process


    Qualifications:

    • 2 Year Degree
    • Qualified candidates will be self-directed, assertive, and creative in problem-solving, as well as a keen eye for detail
    • Very strong computer literacy and high competency in the use of Microsoft Office are a must
    • Strong analytical skills
    • Strong oral and written communication skills
    • Ability to work under pressure and meet deadlines while managing multiple high priorities and maintain a flexible schedule


    • Schedule: 5, 8-hour shifts each week - which includes a Saturday and Sunday rotation
    • Scheduled 8 hours per day, between the hours 7am to7:00pm Mountain Time

  • 1 Day Ago

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Claims Manager
  • Missouri Employers Mutual
  • Springfield, MO FULL_TIME
  • Are you driven to keep people safe? That’s what we do every day at Missouri Employers Mutual. We’ve created a casual, values-driven work culture that’s making a positive impact on the way people live ...
  • 19 Days Ago

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Manager
  • Subway Manager
  • California, MO FULL_TIME
  • Responsibilities: Monitor and manage the business. Calculate and ensure the accuracy of financial records. Manage and supervise workers. Be able to make labor and food cost,schedule work hours,weekly ...
  • 1 Month Ago

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Medical Claims Examiner
  • QPS Employment Group
  • Springfield, MO FULL_TIME
  • Position Title: Medical Claims Examiner Wage: $16-$17/hour Shift: 1st Hours: 9am-5:30pm Monday-Friday QPS Employment Group is hiring a Medical Claims Examiner at a great company in the Springfield are...
  • 1 Day Ago

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FARM MANAGER – GAME – FM1499
  • Farm Manager SA
  • River, IN OTHER
  • Limpopo River Area – Limpopo: Our client is looking for a Farm Manager- Game to join the team. Only candidates with the relevant experience will be considered. MINIMUM REQUIREMENTS Agricultural Diplom...
  • 4 Days Ago

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Clinic Manager (Medical and BH - Camdenton/Laurie)
  • Central Ozarks Medical Center
  • Camdenton, MO FULL_TIME
  • We are expanding our team to serve the needs of our community in the Lake of the Ozarks, Missouri area! Central Ozarks Medical Center (COMC) is excited to announce an opening for a Medical and Behavio...
  • 4 Days Ago

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0 Medical Claims Review Manager jobs found in Springfield, MO area

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RN - Psych, Days Full time
  • Mercy
  • Springfield, MO
  • SIGN ON BONUS AVAILABLE NO CONTRACT Incentives: New Grad Sign on Bonus up to $5,000 Experienced Nurse Sign on Bonus up t...
  • 3/29/2024 12:00:00 AM

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RN/LPN Home Care
  • Phoenix Home Care
  • Springfield, MO
  • Seeking a few RNs or LPNs to help with our In-Home Nursing department in the Springfield, MO and surrounding areas. We a...
  • 3/29/2024 12:00:00 AM

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RN - Graduate Nurse Resident, Psych Acute, Nights, Full time
  • Mercy
  • Springfield, MO
  • SIGN ON BONUS AVAILABLE NO CONTRACT Incentives: New Grad Sign on Bonus up to $5,000 Experienced Nurse Sign on Bonus up t...
  • 3/29/2024 12:00:00 AM

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RN - Graduate Nurse Resident, Psych Acute, Nights, Full time
  • Mercy
  • Springfield, MO
  • SIGN ON BONUS AVAILABLE NO CONTRACT Incentives: New Grad Sign on Bonus up to $5,000 Experienced Nurse Sign on Bonus up t...
  • 3/28/2024 12:00:00 AM

M
RN - Psych, Part time, days
  • Mercy
  • Springfield, MO
  • Our patient population consists of individuals with depression, anxiety, mood swings, psychosis or trauma impacted condi...
  • 3/28/2024 12:00:00 AM

M
RN - Psych, Days Full time
  • Mercy
  • Springfield, MO
  • SIGN ON BONUS AVAILABLE NO CONTRACT Incentives: New Grad Sign on Bonus up to $5,000 Experienced Nurse Sign on Bonus up t...
  • 3/28/2024 12:00:00 AM

M
RN - Psych, Part time, days
  • Mercy
  • Springfield, MO
  • Our patient population consists of individuals with depression, anxiety, mood swings, psychosis or trauma impacted condi...
  • 3/27/2024 12:00:00 AM

H
Remote Licensed Clinical Psychologist
  • Headway - Design & Development
  • Springfield, MO
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 3/27/2024 12:00:00 AM

Springfield is the third-largest city in the state of Missouri and the county seat of Greene County. As of the 2010 census, its population was 159,498. As of 2017, the Census Bureau estimated its population at 167,376. It is the principal city of the Springfield metropolitan area, which has a population of 462,369 and includes the counties of Christian, Dallas, Greene, Polk, Webster. Springfield's nickname is "Queen City of the Ozarks" and it is known as the "Birthplace of Route 66". It is home to three universities, Missouri State University, Drury University, and Evangel University. Springf...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$91,005 to $116,033
Springfield, Missouri 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