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)
General Summary
This is a PRN position with a requirement to work a minimum 2 weekend shifts per month & 1 holiday per year.
MUST have 3-5 years clinical experience in a healthcare setting and have previous Utilization Management experience.
Under general supervision, provides utilization review for an assigned patient case load. This role utilizes nationally recognized care guidelines/criteria to assess the patient’s need for outpatient or inpatient care as well as the appropriate level of care. The role requires interfacing with the case managers, medical team, other hospital staff, physician advisors and payers.
Principal Responsibilities and Tasks
Our growing community hospital serving Maryland’s Charles County offers all of the services and amenities of a bigger metro hospital with the personal attention of our caring staff. At University of Maryland Charles Regional Medical Center (UM CRMC), our talented and diverse groups of professionals represent our strength. Through teamwork and a collaborative work environment, we proudly serve our patients and our community with unwavering commitment. It’s our passion for people that motivates us to do great work every single day.
We are consistently named among the top 100 Best Places to Work in Maryland. Employees have the opportunity to grow professionally in a supportive and stimulating environment. Our excellent employee benefits support a healthy, balanced lifestyle.
All your information will be kept confidential according to EEO guidelines.
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