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)
VIVA HEALTH, ranked one of the nation's Best Places to Work by Modern Healthcare, is seeking a Case Manager, Utilization Review position to join our team in Birmingham, AL!
VIVA HEALTH knows that nursing is not just a job; it is a calling. If you would like to fulfill your calling in healthcare, check us out! We offer regular hours with no mandatory nights and weekends. This way, you can do what you love at work and take care of the people you love at home! We also offer a great benefits package, including tuition reimbursement for employees and dependents, 401(K), paid parental leave, and paid day for community service, just to name a few!
VIVA HEALTH is the first and only Alabama-based plan to be named an overall 5-out-of-5 Star Medicare Advantage Plan for the third year in a row! Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys. Come join our team!
The Case Manager, Utilization Review will assist in the development, planning, coordination, and administration of the activities involved in utilization review for VIVA HEALTH members and assigned UAB High-Risk Fund-approved patients. This position will perform timely medical records checks to determine the appropriateness and medical necessity of admission, continued stay, and use of ancillary services. These duties may be performed on-site or telephonically depending on the location. This position may travel to locations within the VIVA HEALTH service area through a reliable means of transportation insured following Company policy. This position will have work-from-home opportunities.
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