Medical Claims Review Manager jobs in Hilton Head Island, SC
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)
Recently Added Medical Claims Review Manager jobs
- Hilton Head Regional Medical Center
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Hilton, SC
OTHER
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About Hilton Head Regional Healthcare
Hilton Head Regional Healthcare provides comprehensive healthcare to the Lowcountry at four locations including Coastal Carolina Hospital, Hilton Head Hospital, the Bluffton Medical Campus and the Bluffton-Okatie Outpatient Center. Coastal Carolina Hospital (CCH) is a 41-bed acute care hospital located in Hardeeville, S.C., serving the medical and healthcare needs of Jasper and Beaufort counties since November 2004. Hilton Head Hospital (HHH) is a 109-bed acute care hospital located on Hilton Head Island, S.C. Opened in 1974, HHH serves Hilton Head Island, Bluffton, Okatie and surrounding counties. All facilities are owned and operated by Dallas-based Tenet Healthcare Corp. Both hospitals are accredited by The Joint Commission, the nation’s oldest and largest hospital accreditation agency. Learn more about Hilton Head Regional Healthcare at www.hiltonheadregional.com.About Hilton Head Hospital
Hilton Head Hospital (HHH) is a 109-bed acute care hospital located at 25 Hospital Center Boulevard in Hilton Head Island, SC. Opened in 1974, HHH serves Hilton Head Island, Bluffton, Okatie and surrounding counties through its care team of over 600 colleagues and over 100 physicians. The hospital provides a continuum of services through its centers and programs, including a 24-hour emergency department, critical care, cardiac care ranging from minimally invasive to open heart surgery, obstetrics/gynecology, urology, a nationally accredited breast health center, spine care, gastroenterology, surgical services, cardiac and physical rehabilitation, and a 12-bed geriatric psychiatric inpatient unit. To learn more about Hilton Head Hospital, please visit www.hiltonheadregional.com.RN Case Manager Utilization Review Full Time Days Position Summary
The RN Case Manager is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient’s resources and right to self-determination. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity and to assess the patient for transition needs to promote timely throughput, safe discharge and prevent avoidable readmissions. This position integrates national standards for case management scope of services including: • Utilization Management supporting medical necessity and denial prevention• Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction• Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care• Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy• Education provided to physicians, patients, families and caregivers
ResponsibilitiesThe individual’s responsibilities include the following activities:a) accurate medical necessity screening and submission for Physician Advisor review,b) care coordination,c) transition planning assessment and reassessment,d) implementation or oversight of implementation of the transition plan,e) leading and facilitating multi-disciplinary patient care conferences,f) managing concurrent disputes,g) making appropriate referrals to other departments,h ) identifying and referring complex patients to Social Work Services,I) communicating with patients and families about the plan of care,j) collaborating with physicians, office staff and ancillary departments,k) leading and facilitating Complex Case Review,l) assuring patient education is completed to support post-acute needs ,m) timely complete and concise documentation in Case Management system,n ) maintenance of accurate patient demographic and insurance information,o) identification and documentation of potentially avoidable days,p) identification and reporting over and underutilization,q) and other duties as assignedTHE RN CASE MANAGAER UTILIZATION REVIEW FULL TIME DAYS CANDIDATE WILL POSSESS THE FOLLOWING EDUCATION, LICENSE/CERTIFICATIONS, AND EXPERIENCE.
Education
Required: Graduate of an accredited school of nursing.Preferred: Academic degree in nursing (bachelor's or master's)Experience
Required: 2 years of acute hospital patient care experience.Preferred: Acute hospital case management experience.Certification
Required: RN. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN license for state(s) covered.Preferred: Accredited Case Manager (ACM)2403013622 - Just Posted
- Hilton Head Regional Medical Center
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Hilton, SC
OTHER
- About Hilton Head Regional Healthcare Hilton Head Regional Healthcare provides comprehensive healthcare to the Lowcountry at four locations including Coastal Carolina Hospital, Hilton Head Hospital, t...
- Just Posted
- Aware Manager
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Savannah, GA
FULL_TIME,PART_TIME
- CleanerWe are looking for a Cleaner to take care of our facilities and carry out cleaning and maintenance duties. The goal is to keep our building in a clean and orderly condition.ResponsibilitiesClea...
- 1 Month Ago
- Glow Medical Spa
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Savannah, GA
FULL_TIME
- Position: Manager Reporting To: Spa Director and CEO/Owner Job Summary: responsible for overseeing the day-to-day operations of the spa. Ensuring that all staff members are performing their jobs effec...
- 1 Month Ago
- Coastal Behavioral Health
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Savannah, GA
FULL_TIME
- Responsibilities: Coastal Harbor Health System offers compassionate care when you or your loved ones need it most. Our experienced team of doctors, nurses and therapists are specialists in behavioral ...
- 1 Month Ago
- Product Review Jobs
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Mershon, GA
FULL_TIME
- Compensation: Varies per assignment. Up to $500 per week.Location: Remote (USA)Company: ProductReviewJobsThank you for your interest in becoming a Paid Product Tester. This opportunity is for completi...
- 28 Days Ago
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0 Medical Claims Review Manager jobs found in Hilton Head Island, SC area
- EOS Hospitality
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Hilton Head Island, SC
- Responsibilities: * Greet guests as they approach the bar; promote house drinks and utilize up-selling skills to maximiz...
- 4/25/2024 12:00:00 AM
- The TJX Companies, Inc.
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Hilton Head Island, SC
- Opportunity: Contribute To The Growth Of Your Career Responsible for delivering a highly satisfied customer experience p...
- 4/25/2024 12:00:00 AM
- MasterCorp
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Hilton Head Island, SC
- Overview Get your hospitality career started with MasterCorp, the industry leader in housekeeping and hospitality servic...
- 4/25/2024 12:00:00 AM
- LifeStance Health
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Savannah, GA
- At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make liv...
- 4/24/2024 12:00:00 AM
- Hilton Head Regional Medical Center
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Hilton Head Island, SC
- Up to $15,000 Sign-on Bonus Based on Eligibility About Hilton Head Regional Healthcare Hilton Head Regional Healthcare p...
- 4/24/2024 12:00:00 AM
- WALGREENS
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Okatie, SC
- Job Objectives Provides pharmacy consulting services with empathy to patients regarding the effective usage of medicatio...
- 4/23/2024 12:00:00 AM
- Headway
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Savannah, GA
- Remote Licensed Psychiatrist Wage: Between $106 - $261 an hour Are you a licensed Psychiatrist looking to launch a priva...
- 4/21/2024 12:00:00 AM
- Headway
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Savannah, GA
- Remote Licensed Psychiatric Nurse Practitioner Wage: Between $126-$220 an hour Are you a licensed Psychiatric Nurse look...
- 4/21/2024 12:00:00 AM
About Hilton Head Island, South Carolina
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