Medical Policy Manager jobs in Raleigh, NC

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)

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Policy Manager Center for Nursing Excellence
  • UNC Health
  • Chapel Hill, NC FULL_TIME
  • Description

    Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

    Join our Center for Nursing Excellence team as we seek a dynamic and motivated Policy Manager!

    In this role, you will oversee the organization's electronic policy system, guide end-users through the policy process and ensure compliance with internal and external regulatory standards. You will also play a key role in fostering a culture of evidence-based practice. Strong communication abilities, interpersonal skills, attention to detail and expertise with collaborating effectively with various stakeholders are essential for success in this role.


    Responsibilities:


    1.Policy Management – Oversees the organization’s electronic policy system, providing support to users throughout the policy process including development, regular review and interim assessments of policies, procedures, guidelines and related documents.

    2.Technologies – Manages the organization’s electronic policy management system, liaison with vendors as necessary. Implements backup measures to mitigate technology failures.

    3.Accreditation Compliance - Ensures that policies, procedures and associated documents meet or exceed internal and external regulatory standards. Responds to requests from accreditation bodies as it relates to policies, procedures, guidelines, standing orders and other documents.

    4.Legal Collaboration – Works collaboratively with hospital attorneys and risk management to address and respond to legal requests pertaining to policies, procedures, guidelines and documents.

    5.Evidence-Based Practice – Works collaboratively to ensure policies, procedures and guidelines reflect evidence-based standards of care.

    6.Customer Satisfaction - Fosters high levels of customer satisfaction among both internal and external stakeholders by promptly addressing inquiries and serving as a resource for complex service and administrative matters. Interprets and communicates policies and procedures effectively based on organizational knowledge.

    7.Educational Programs -Independently assesses needs, designs, develops, implements and evaluates educational programs for hospital employees with a focus on policy, procedure, guideline, standing orders and scope of service.

    8.Planning -Develops strategic plan, goals, associated metrics and annual evaluation for the program.

    9.Quality Improvement - Leads improvement efforts to maintain the quality of the policy, procedure, guideline and document process. Engages with interprofessional stakeholders to lead change.

    10.Professional Growth and Development – Demonstrates responsibility for own professional growth and development. Maintains current certification in clinical specialty, leadership or Nursing Professional Development.


    Other Information

    Other information:
    Education Requirements:
    • Bachelor's degree in Nursing (BSN) from a state-accredited school of professional nursing.
    Licensure/Certification Requirements:
    • Licensed to practice as a Registered Nurse in the state of North Carolina.
    Professional Experience Requirements:
    • Three (3) years of professional nursing experience in a tertiary care and one (1) year of management experience in specialty area.
    • Each year of accredited residency may substitute for two (2) years of experience.
    Knowledge/Skills/and Abilities Requirements:


    Job Details

    Legal Employer: STATE

    Entity: UNC Medical Center


    Organization Unit: Center of Nursing Excellence

    Work Type: Full Time


    Standard Hours Per Week: 40.00

    Salary Range: $34.65 - $49.81 per hour (Hiring Range)


    Pay offers are determined by experience and internal equity


    Work Assignment Type: Onsite

    Work Schedule: Day Job

    Location of Job: US:NC:Chapel Hill

    Exempt From Overtime: Exempt: Yes


    This is a State position employed by UNC Health Care System.


    Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

    UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.

  • 7 Days Ago

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Senior Product Manager - Policy Administration System
  • Zachary Piper Solutions, LLC
  • Raleigh, NC FULL_TIME
  • Job DetailsPiper Companies currently has an exciting Senior Product Manager opportunity available with an InsureTech organization located in Raleigh, NC. The Product Manager will work with the Applica...
  • 15 Days Ago

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Sr. Product Manager (Insurance - Policy Admin System)
  • Zachary Piper Solutions, LLC
  • Durham, NC FULL_TIME
  • Job DetailsPiper Companies is currently seeking a Sr. Product Manager (Insurance - Policy Admin System) for an award winning company located in Durham, North Carolina. The Product Manager (Insurance -...
  • 8 Days Ago

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Medical Office Administrative Manager
  • Regional Medical Oncology Center
  • Wilson, NC FULL_TIME
  • Overview:We are seeking a highly organized and detail-oriented Administrative Manager to join our team. As an Administrative Manager, you will be responsible for overseeing the daily administrative op...
  • 8 Days Ago

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Policy Analyst
  • TRC Talent Solutions
  • Raleigh, NC FULL_TIME
  • TRC’s client is an established insurance company that provides various product lines such as home, auto, farm, commercial, marine, personal property, and more. With a strong emphasis on community, col...
  • 11 Days Ago

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ASC Manager
  • Pinehurst Medical
  • Sanford, NC FULL_TIME
  • Position SummaryPinehurst Medical Clinic is seeking ASC Manager to join our GI section in Sanford, NC. This position plays a key role in patient care working with our providers in providing the best i...
  • 2 Months Ago

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Driver - 2 Day Project!
  • The Greer Group, Inc.
  • Raleigh, NC
  • Job Description Job Description The Greer Group is recruiting for a 2 Day Voting Project for our client in Raleigh! This...
  • 4/19/2024 12:00:00 AM

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Remote Licensed Psychiatric Nurse Practitioner
  • Headway
  • Raleigh, NC
  • 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 Psychiatrist
  • Headway
  • Raleigh, NC
  • 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 Clinical Social Worker
  • Headway
  • Raleigh, NC
  • 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 Mental Health Therapist
  • Headway
  • Raleigh, NC
  • 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 Mental Health Counselor
  • Headway
  • Raleigh, NC
  • 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 Professional Counselor
  • Headway
  • Raleigh, NC
  • 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
  • Raleigh, NC
  • 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

According to the United States Census Bureau, Raleigh occupies a total area of 144.0 square miles (373.0 km2), of which 142 square miles (369 km2) is land and 0.97 square miles (2.5 km2), or 0.76%, is covered by water. The Neuse River flows through the northeast end of the city. Raleigh is located in the northeast central region of North Carolina, where the Piedmont and Atlantic Coastal Plain regions meet. This area is known as the "fall line" because it marks the elevation inland at which waterfalls begin to appear in creeks and rivers. As a result, most of Raleigh features gently rolling hil...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Policy Manager jobs
$127,574 to $155,742
Raleigh, North Carolina area prices
were up 1.5% from a year ago

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