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)
Job Summary: The Medical Case Manager (LVN) will be responsible for reviewing and processing requests for authorization and notification of medical services from health professionals, clinical facilities and ancillary providers. The incumbent will be responsible for prior authorization and referral related processes, which includes online responsibilities as well as select off-line tasks. The incumbent will utilize medical criteria, policies and procedures to authorize referral requests from medical professionals, clinical facilities and ancillary providers. The incumbent will directly interact with provider callers and serve as a resource for their needs.
Position Responsibilities
Possesses
the Ability To:
Experience & Education
Preferred Qualifications
At Sunshine Enterprise USA LLC, we firmly believe that our
employees are the heartbeat of our organization, and we are happy to offer the
following benefits:
SUNSHINE ENTERPRISE USA LLC is an
Equal Opportunity Employer and does not discriminate based on race or
ethnicity, religion, sex, national origin, age, veteran disability or genetic
information or any other reason prohibited by law in employment.
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