Medical Management Manager jobs in Rochester, NY

Medical Management Manager manages the organization's medical management programs, which may include case management, utilization review, quality management, or community health education programs with the goal of providing high quality, cost effective health care services. Collects and analyzes data on utilization, outcomes, safety, and costs to determine trends and identify problem areas. Being a Medical Management Manager presents findings, proposed solutions, and implementation plans to management. Implements long and short term solutions for improvements in patient care and cost savings. Additionally, Medical Management Manager requires a bachelor's degree. Typically reports to a head of a unit/department. The Medical Management 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 Management 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 Management Specialist
  • Erie Insurance
  • Rochester, NY FULL_TIME
  • Division or Field Office:
    New York Branch Office


    Department of Position:
    Claims Department


    Work from:
    New York Branch Office

    Salary Range:
    $50,789.00 - $81,131.00 *
    salary range is for this level and may vary based on actual level of role hired for

    • This range represents a national range and the actual salary will depend on several factors including the scope and complexity of the role and the skills, education, training, credentials, location, and experience of an applicant, as well as level of role for which the successful candidate is hired. Position may be eligible for an annual bonus payment.

    At Erie Insurance, you’re not just part of a Fortune 500 company; you’re also a valued member of a diverse and inclusive team that includes more than 6,000 employees and over 13,000 independent agencies. Our Employees work in the Home Office complex located in Erie, PA, and in our Field Offices that span 12 states and the District of Columbia.

    Benefits That Go Beyond The Basics
    We strive to be Above all in Service® to our customers—and to our employees. That’s why Erie Insurance offers you an exceptional benefits package, including:
    • Premier health, prescription, dental, and vision benefits for you and your dependents. Coverage begins your first day of work.
    • Low contributions to medical and prescription premiums. We currently pay up to 97% of employees’ monthly premium costs.
    • Pension. We are one of only 13 Fortune 500 companies to offer a traditional pension plan. Full-time employees are vested after five years of service.
    • 401(k) with up to 4% contribution match. The 401(k) is offered in addition to the pension.
    • Paid time off. Paid vacation, personal days, sick days, bereavement days and parental leave.
    • Career development. Including a tuition reimbursement program for higher education and industry designations.
    Additional benefits that include company-paid basic life insurance; short-and long-term disability insurance; orthodontic coverage for children and adults; adoption assistance; fertility and infertility coverage; well-being programs; paid volunteer hours for service to your community; and dollar-for-dollar matching of your charitable gifts each year.

    Position Summary
    Within designated authority, handles medical management claims with limited supervision.
    Duties and Responsibilities
    Handles first party medical benefit claims, including fatalities and wage loss claims. Evaluates and makes decisions regarding coverage. Conducts investigations, determines total value of claims, sets and maintains adequate reserves, and manages cases.
    Prepares related correspondence and reports, obtains medical and employment related records, calculates wage loss claims per applicable state laws and brings claims to conclusion.
    Investigates, evaluates, and resolves coverage questions in compliance with applicable state laws.
    Establishes immediate contact with Policyholders and Claimants. Contacts Agents as necessary.
    Reviews claim files on a regular basis and takes necessary follow-up and/or closing action.
    Evaluates, processes and takes appropriate action on claim-related bills and medical, rehabilitation and special investigative reports. Determines claims to be paid, compromised or contested.
    Coordinates activities with the Home Office on serious or massive injury cases. Notifies company investigative services of cases involving suspected fraud.
    When appropriate manages claims in litigation and assist in the development of case strategy with legal counsel.

    Duties and Responsibilities (cont'd if applicable)
    Attends industry-related training programs to stay current on legal developments and ensure compliance with applicable laws and regulations impacting the operation of the department.
    Assists or acts on the behalf of supervisor when required, including handling of insurance department complaints.
    When appropriate identifies subrogation situations and initiates appropriate action.
    Develops expertise in legal and medical terminology and procedures.
    Assists in training branch office personnel in related matters.
    Assigns, monitors and controls activities of vendors in a cost-effective manner.
    The first five duties listed are the functions identified as essential to the job. Essential functions are those job duties that must be performed in order for the job to be accomplished.
    This position description in no way states or implies that these are the only duties to be performed by the incumbent. Employees are required to follow any other job-related instruction and to perform any other duties as requested by their supervisor, or as become evident.
    Competencies
    Values Diversity
    Job-Specific Knowledge
    Self-Development
    Nimble Learning
    Collaborates
    Customer Focus
    Cultivates Innovation
    Optimizes Work Processes
    Instills Trust
    Ensures Accountability
    Decision Quality
    Qualifications
    Minimum Required Education Equivalents:
    High School Diploma or GED and two years of general claims handling experience required, or;
    Bachelor’s Degree required.
    OR completion of formal ERIE training program, required.
    Strong working knowledge of applicable state laws preferred.
    Good working knowledge of human anatomy and medical terminology preferred.
    Expertise in state no-fault laws and working knowledge of civil law preferred.
    Successful completion of AIC courses preferred.
    Working knowledge of medical bill repricing system preferred.
    Appropriate license as required by state.
    Physical Requirements
    Lifting/Moving 0-20 lbs; Occasional (<20%)
    Lifting/Moving 20-50 lbs; Occasional (<20%)
    Ability to move over 50 lbs using lifting aide equipment; Occasional (<20%)
    Driving; Rarely
    Pushing/Pulling/moving objects, equipment with wheels; Occasional (<20%)
    Manual Keying/Data Entry/inputting information/computer use; Often (20-50%)
    Climbing/accessing heights; Rarely


    Nearest Major Market: Rochester

  • 1 Month Ago

V
Medical Technologist
  • VINCENT MANAGEMENT GROUP & ASSOCIATES, Inc.
  • Rochester, NY FULL_TIME
  • Evening Shift$65 per hour. $1660 Taxed. $940 StipendsMedical Technologist Responsibilities: Medical technologist will perform laboratory tests on patient specimens, ensuring accuracy, precision, and t...
  • 2 Days Ago

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Civil Engineer - Project Engineer / Manager
  • Project Engineer / Manager - LaBella Associates
  • Rochester, NY FULL_TIME
  • We are in search of a capable candidate to play a key role in a broad spectrum of projects, encompassing everything from large utility infrastructure projects and athletic fields to land development w...
  • 18 Days Ago

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Garage Clothing-Store Manager-Eastview Mall-Victor, NY
  • Garage clothing-Store Manager-Eastview...
  • Victor, NY FULL_TIME
  • Seize the opportunity to join a global fashion retailer with two brands at the heart of its success, Garage and Dynamite, selected as one of Montreal's Top Employers 2020 and as one of Canada’s Top em...
  • 11 Days Ago

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Store Manager
  • Garage clothing-Store manager-Eastview mall-Victor...
  • Victor, NY FULL_TIME
  • Seize the opportunity to join a global fashion retailer with two brands at the heart of its success, Garage and Dynamite, selected as one of Montreal's Top Employers 2020 and as one of Canada’s Top em...
  • 22 Days Ago

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Hotel Front Office Manager
  • Thind Management
  • Rochester, NY FULL_TIME
  • Front Office Manager/Front Desk SupervisorIntroductionWelcome to Thind Management, a family-owned management company where we strive to provide exceptional service and unforgettable experiences to our...
  • 3 Days Ago

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0 Medical Management Manager jobs found in Rochester, NY area

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Remote Licensed Mental Health Therapist
  • Headway
  • Rochester, NY
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/25/2024 12:00:00 AM

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Remote Licensed Clinical Psychologist
  • Headway
  • Rochester, NY
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/25/2024 12:00:00 AM

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Remote Licensed Mental Health Counselor
  • Headway
  • Rochester, NY
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/25/2024 12:00:00 AM

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Remote Licensed Psychiatrist
  • Headway
  • Rochester, NY
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/25/2024 12:00:00 AM

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Remote Licensed Psychiatric Nurse Practitioner
  • Headway
  • Rochester, NY
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/25/2024 12:00:00 AM

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Remote Licensed Clinical Social Worker
  • Headway
  • Rochester, NY
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/25/2024 12:00:00 AM

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Remote Licensed Professional Counselor
  • Headway
  • Rochester, NY
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/24/2024 12:00:00 AM

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Remote Licensed Marriage and Family Therapist
  • Headway
  • Rochester, NY
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/23/2024 12:00:00 AM

Rochester is at 43°9′56″N 77°36′41″W / 43.16556°N 77.61139°W / 43.16556; -77.61139 (43.165496, −77.611504). The city is about 73 miles (120 km) east-northeast of Buffalo and about 87 miles (140 km) west of Syracuse and Albany, the state capital is 226 miles (360 km) to the east ; it sits on Lake Ontario's southern shore. The Genesee River bisects the city. Toronto, Canada is northwest 168 miles (270 km) and New York City is about 350 miles (560 km) to the southeast. According to the United States Census Bureau, the city has a total area of 37.1 square miles (96 km2), of which 35.8 square m...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Management Manager jobs
$109,051 to $135,495
Rochester, New York area prices
were up 1.5% from a year ago

Medical Management Manager in Des Moines, IA
Organize, monitor and control the business operations of a healthcare facility including medical office, nursing home, clinic, hospital and healthcare practitioner.
November 28, 2019
Medical Management Manager in Dayton, OH
Its case management program involves trained nurse case managers offering free service and support, helping members manage their benefits, arrange care and find resources.
January 18, 2020
Medical Management Manager in Danbury, CT
Reporting to the Head of Medical, this role will drive patient outcomes and business success, using scientific expertise to inspire, partner and lead in a designated therapeutic area(s).
January 08, 2020