Medical Policy Manager manages and implements corporate policy and process for medical provider and other reimbursements. Ensures that all claims are reviewed, settled, and processed in compliance with and according to contract provisions and regulatory requirements. Being a Medical Policy Manager evaluates and develops policies and provider reimbursement guidelines to effectively manage and control medical claims cost. Requires a bachelor's degree of finance, business or healthcare administration. Additionally, Medical Policy Manager typically reports to head of a unit/department. The Medical Policy 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 Policy 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)
This is a full-time position for a licensed social worker with medical case management experience and a strong desire to work in a hospital setting, as well as an outpatient setting. Must be empathetic, and an organized individual with excellent communication and prioritization skills, who has a high interest in healthcare. The Medical Case Manager will provide direct hospital and outpatient care coordination for our patients and assist our physicians to meet emerging quality metrics. The Medical Case Manager’s role is to liaison with a patient, their family, and the patient's healthcare providers to coordinate medical and community resources in order to improve patient health outcomes.
SECONDARY DUTIES AND RESPONSIBILITIES:
Bachelor of Social Work (BSW). Current, unencumbered licensure as a Licensed Baccalaureate Social Worker (LBSW). Two (2) years of social work and/or case management experience required.
Experience with the MS Office Suite of products, including Excel.
EHR experience a plus.
KNOWLEDGE, SKILLS AND ABILITIES:
Eager to learn more about the social and medical support requirements of our practice population.
Personal interest in health and wellness that will inform patient education for lifestyle choices.
Critical thinking, prioritization, and organization skills that contribute to improving patient outcomes.
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0 Medical Policy Manager jobs found in Norfolk, VA area