Medical Claims Review Manager jobs in Chula Vista, CA

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)

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Senior Manager, Medical Information, and Review
  • Acadia Pharmaceuticals Inc.
  • San Diego, CA FULL_TIME
  • This position will serve as an integral member of Medical information (MI) and Medical Review (MLR/MRC) teams responsible for medical accuracy review as part of the Promotional Review Committee and Medical Review Committee, the support of the Medical Information Call Center (MICC), including the development and maintenance of MI content, as well as operational and scientific support for key strategic Medical Affairs initiatives.

    Primary Responsibilities
    • Participates in the review of promotional and medical materials to ensure medical accuracy.
    • Maintains an understanding of product knowledge and labeling, associated disease states, relevant literature, treatment guidelines, competitor information, and marketing strategies and tactics for assigned therapeutic area(s).
    • Critically evaluates literature, interprets complex data, writes efficiently, and communicates recommendations to counterparts from cross-divisional functional areas.
    • Collaborate cross-functionally with internal collaborators, including MSL field directors, training, medical information, publications, HEOR, clinical development, and pharmacovigilance to identify, develop, and review scientific content for external use by Medical Affairs.
    • Develops and manages a Medical Reference Library as well as a Medical digital asset management system to ensure references are up-to-date and linked to materials as appropriate.
    • Develops MI content, including verbal responses (FAQs) and standard response letters (SRLs) to be used by the MICC and Medical Information team.
    • Leads the development of custom responses for specific requests that require escalated attention.
    • Ensure the responses to inquiries are provided in an accurate and timely manner.
    • Develops Medical Information reports to assist with identifying data gaps and communicating key performance indicators.
    • Monitors the Medical Information and Medical Affairs inbox for inquiries.
    • Provides support for compendia updates.
    • Other duties as assigned
    Education/Experience/Skills
    • Requires a PharmD or advanced degree in a scientific subject area.
    • Targeting 3 years' progressively responsible experience in the pharmaceutical industry in medical affairs, medical communications, medical information, scientific affairs, or similar area, or completion of a pharmaceutical industry fellowship. Previous experience in neurology, psychiatry and/or rare disease preferred.
    • An equivalent combination of relevant education and experience may be considered.
    • Understanding of the US healthcare environment, FDA and other federal regulations, and ethical guidelines.
    • Strong written and verbal communication skills with the ability to handle information flow among a variety of partners.
    • Ability to run multiple projects simultaneously.
    • Excellent organizational and multi-tasking skills.
    • Ability to promote team cooperation and a dedication to team success.
    • Self-directed with sense of urgency with commitment to tasks at hand.
    • Ability to build and sustain trusted relationships both internally and externally.
    Physical Requirements

    While performing the duties of this job, the employee is regularly required to stand; walk; sit; use hands to finger, handle, or feel; reach with hands and arms; climb or balance; stoop, kneel, crouch, see, talk or hear in a standard office environment and independently from remote locations. Employee must occasionally lift and/or move up to 20 pounds. Ability to travel independently overnight and work after hours if required by travel schedule or business issues.

    #LI-KA1 #LI-HYBRID

    In addition to a competitive base salary, this position is also eligible for discretionary bonus and equity awards based on factors such as individual and organizational performance. Actual amounts will vary depending on experience, performance, and location.

    Salary Range
    $126,000-$157,300 USD

    What we offer you (US-Based Employees):

    • Competitive base, bonus, new hire and ongoing equity packages
    • Medical, dental, and vision insurance
    • 401(k) Plan with a fully vested company match 1:1 up to 5%
    • Employee Stock Purchase Plan with a 2-year purchase price lock-in
    • 15 vacation days
    • 14 paid holidays plus one floating holiday of your choice, including office closure between December 24th and January 1st
    • 10 days of paid sick time
    • Paid parental leave
    • Tuition assistance

    EEO Statement (US-Based Employees): Studies have shown that women and people of color are less likely to apply for jobs unless they believe they meet every single one of the qualifications in the exact way they are described in job postings. We are committed to building a diverse, equitable, inclusive, and innovative company and we are looking for the BEST candidate for the job. That candidate may be one who comes from a less traditional background or may meet the qualifications in a different way. We would strongly encourage you to apply - especially if the reason you are the best candidate isn't exactly as we describe it here.

    It is the policy of Acadia to provide equal employment opportunities to all employees and employment applicants without regard to considerations of race, including related to hairstyle, color, religion or religious creed, sexual orientation, gender, gender identity, gender expression, gender transition, country of origin, ancestry, citizenship, age, physical or mental disability, genetic information, legally-protected medical condition or information, marital status, domestic partner status, family care status, military caregiver status, veteran or military status (including reserve status, National Guard status, and military service or obligation), status as a victim of domestic violence, sexual assault or stalking, enrollment in a public assistance program, or any basis protected under federal, state or local law.

    As an equal opportunity employer, Acadia is committed to a diverse workforce. If you are a qualified individual with a disability or a disabled veteran, you have the right to request a reasonable accommodation. Furthermore, you may request additional support if you are unable or limited in your ability to use or access Acadia's career website due to your disability, along with any accommodations throughout the interview process. To request or inquire about your reasonable accommodation, please complete our or contact us at or .

    Please note that reasonable accommodations granted throughout the recruiting process are not guaranteed to be the same accommodation given if hired. A new request will need to be submitted for any ADA accommodations after starting employment.

    Notice for California Applicants: Please within our Privacy Policy.

    Notice to Search Firms/Third-Party Recruitment Agencies (Recruiters): The Talent Acquisition team manages the recruitment and employment process for Acadia Pharmaceuticals Inc. ("Acadia"). Acadia does not accept resumes from recruiters or search firms without an executed search agreement in place. Resumes sent to Acadia employees in absence of an executed search agreement will not obligate Acadia in any way with the respect to the future employment of those individuals or potential remuneration to any recruiter or search firm. Candidates should never be submitted directly to our hiring managers or employees.


    ACADIA is an Equal Employment Opportunity/Affirmative Action Employer: Minority/Female/Disability/Veterans/Sexual Orientation and Gender Identity


     

  • 1 Month Ago

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Medical Bill Review Analyst
  • Enlyte DBA Mitchell International
  • San Diego, CA FULL_TIME
  • Mitchell InternationalMedical Bill Review AnalystUS--RemoteJob ID: 24-16694Type: Regular Full-Time# of Openings: 1Category: Medical Services & SupportMitchell International, Inc.OverviewThe Enlyte Fam...
  • 13 Days Ago

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Physician Telecommute Medical Review Stream
  • Concentra Career Choice
  • San Diego, CA OTHER
  • Overview Are you an accomplished Board Certified physician in one of the below specialties? Preferred candidates must have a CA license. Neurosurgeon Pain Management/Medicine Are you passionate about ...
  • 23 Days Ago

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AVP, CRE Loan Review Manager
  • Axos Bank
  • HQ, CA FULL_TIME
  • Job Summary and OpportunityReview loan files of the commercial real estate loan portfolio including complex bridge and construction loans. Responsibilities Perform detailed loan file reviews of the co...
  • 20 Days Ago

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Entry Level Medical Bill Review Analyst
  • Enlyte DBA Mitchell International
  • San Diego, CA FULL_TIME
  • Mitchell InternationalEntry Level Medical Bill Review AnalystUS--RemoteJob ID: 24-16702Type: Regular Full-Time# of Openings: 1Category: Medical Services & SupportMitchell International, Inc.OverviewTh...
  • 12 Days Ago

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Workers Compensation Claims Examiner | Must Reside in California
  • Sedgwick Claims Management Services Inc.
  • San Diego, CA FULL_TIME
  • Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flex...
  • 21 Days Ago

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0 Medical Claims Review Manager jobs found in Chula Vista, CA area

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Remote Licensed Mental Health Counselor
  • Headway
  • San Diego, CA
  • Remote Licensed Mental Health Counselor (LMHC) Wage: Between $120-$131 an hour Are you a Licensed Mental Health Counselo...
  • 3/28/2024 12:00:00 AM

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Remote Licensed Psychiatrist
  • Headway
  • San Diego, CA
  • Remote Licensed Psychiatrist Wage: Between $232 - $269 an hour Are you a licensed Psychiatrist looking to launch a priva...
  • 3/27/2024 12:00:00 AM

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Remote Licensed Marriage and Family Therapist
  • Headway
  • San Diego, CA
  • Remote Licensed Marriage and Family Therapist (LMFT) Wage: Between $120-$131 an hour Are you a Licensed Marriage and Fam...
  • 3/27/2024 12:00:00 AM

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Remote Licensed Professional Counselor
  • Headway
  • San Diego, CA
  • Remote Licensed Professional Counselor (LPC) Wage: Between $120-$131 an hour Are you a Licensed Professional Counselor l...
  • 3/26/2024 12:00:00 AM

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Remote Licensed Clinical Social Worker
  • Headway
  • San Diego, CA
  • Remote Licensed Clinical Social Worker (LCSW) Wage: Between $120-$131 an hour Are you a Licensed Clinical Social Worker ...
  • 3/26/2024 12:00:00 AM

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Remote Licensed Clinical Psychologist
  • Headway
  • San Diego, CA
  • Remote Licensed Clinical Psychologist Wage: Between $166-$196 an hour Are you a Licensed Clinical Psychologist looking t...
  • 3/26/2024 12:00:00 AM

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Remote Licensed Mental Health Therapist
  • Headway
  • San Diego, CA
  • Remote Licensed Mental Health Therapist (LMHT) Wage: Between $120-$131 an hour Are you a Licensed Mental Health Therapis...
  • 3/26/2024 12:00:00 AM

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Psychiatrist
  • BlueSky Telepsych
  • San Diego, CA
  • *** Psychiatrist with interest in APN supervision at 300/APN About BlueSky: We are a clinician-led, patient-centered, co...
  • 3/25/2024 12:00:00 AM

Chula Vista (/ˌtʃuːlə ˈvɪstə/; English: beautiful view ) is the second largest city in the San Diego metropolitan area, the seventh largest city in Southern California, the fourteenth largest city in the state of California, and the 74th-largest city in the United States. The population was 243,916 as of the 2010 census. Located just 7.5 miles (12.1 km) from downtown San Diego and 7.5 miles (12.1 km) from the Mexican border in the South Bay region of the metropolitan area, the city is at the center of one of the richest economic and culturally diverse zones in the United States. Chula Vista is...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$105,059 to $133,951
Chula Vista, California area prices
were up 2.6% from a year ago

Medical Claims Review Manager in Paramus, NJ
Support management with leading Medical Review team to ensure all types of claims requiring medical reviews are completed in compliance with State, Federal, accreditation standards and other applicable regulations.
February 01, 2020
Medical Claims Review Manager in Nashua, NH
By truly combining claims and bill review, the two systems are kept in sync utilizing the scheduled jobs of the aforementioned standard model; however, for real-time data updates, claims examiners are granted access to the entire live bill review system.
January 13, 2020
Medical Claims Review Manager in Davenport, IA
Complex claim errors can only be caught by physician reviewers with the clinical experience to spot mistakes that automated systems can’t detect.
January 03, 2020