Medical Claims Review Manager jobs in Maine

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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Social Worker DCP-Utilization Review
  • Pen Bay Medical Center
  • Rockport, ME FULL_TIME
    • Position Summary
        Assesses psychosocial needs of patients. Provides individual and family education and counseling. As part of a multidisciplinary team, identifies issues that can pose a barrier to a safe and timely discharge. Serves as a resource to patients, families, health care team members and the community.
      Required Minimum Knowledge, Skills, and Abilities (KSAs)
      • Education: Bachelor’s degree In Social Work or similar field required
      • License/Certifications: Current Maine State Licensure as LMSW, -or . LCSW or LSW-required
      • Experience: At least two years of health care experience under qualified supervision preferred.
      • Superior inter-personal communication skills
      • Ability to problem solve
      • Ability to prioritize effectively
      • Strong documentation skills
      • Familiar with child abuse and domestic violence issues along with available community resources
      • Knowledge of human growth and development, personality disorders, common medical terms, and diagnoses and prognosis.
      • Counseling ability for patients of all ages and their families
      • Individuals involved with discharge planning must have knowledge pertaining to:
      • Clinical and social factors that affect the patient’s functional status at discharge
      • Community resources to meet post-discharge clinical and social needs and assessment skills
      • Clinical, social, insurance/financial and physical factors that must be considered when evaluating how a patient’s expected post-discharge care needs can be met

    Location: MaineHealth · Utilization Review
    Schedule: Per Diem, Day/Evening, 12
  • 3 Days Ago

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UTILIZATION REVIEW CASE MANAGER
  • Covenant Health
  • Lewiston, ME FULL_TIME
  • JOB SUMMARY Under the supervision of the VP of Patient Care Services/Chief Nursing Officer and directly reporting to the Director of Care Coordination, the UR Case Manager will work collaboratively wi...
  • 24 Days Ago

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ME - 1099 Property Claims Adjuster
  • Copper Claims Services, Inc.
  • Portland, ME FULL_TIME
  • 1099 Property Claims Adjuster Copper Claims Services is a quickly growing independent loss adjusting firm based out of Irvine, CA. Copper Claims Services excels in providing custom claims solutions fo...
  • 4 Days Ago

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Care Manager (RN) - Utilization Review
  • MaineHealth
  • Portland, ME FULL_TIME
  • Summary This is a bargaining unit position Date posted: 01/30/2024 For a limited time MaineHealth is offering up to $10,000 Sign on bonus for all eligible experienced Registered Nurses with 1-3 years ...
  • Just Posted

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Registered Nurse (RN) Care Manager - Utilization Review
  • MaineHealth
  • Belfast, ME FULL_TIME
  • Summary For a limited time MaineHealth is offering up to a $10,000 Sign on bonus for all eligible experienced Registered Nurses with 0-3 years of experience and $20,000 for experienced Registered Nurs...
  • 15 Days Ago

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Registered Nurse (RN) Care Manager - Utilization Review
  • Waldo County General Hospital
  • Belfast, ME FULL_TIME
  • For a limited time MaineHealth is offering up to a $10,000 Sign on bonus for all eligible experienced Registered Nurses with 0-3 years of experience and $20,000 for experienced Registered Nurses with ...
  • 16 Days Ago

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Head of Medical Writing
  • Morgan Prestwich - Life Science & Healthcare Executive Search
  • Company Overview Morgan Prestwich is thrilled to be representing our client on an exclusive basis. Our client is a clini...
  • 3/29/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Orem, UT
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/28/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Fairfield, CA
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/28/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Folsom, CA
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/28/2024 12:00:00 AM

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Medical Lead - Oncology, Medical Affairs
  • SEC Life Sciences
  • One of the world's leading pharmaceutical companies is seeking four passionate, forward-thinking individuals for key rol...
  • 3/28/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco
  • Menifee, CA
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/27/2024 12:00:00 AM

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Medication Management Associate
  • Fresenius Medical Care
  • Bluffton, IN
  • PURPOSE AND SCOPE: Promotes quality patient care, ongoing customer support and case management for Fresenius Medical Car...
  • 3/27/2024 12:00:00 AM

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Executive Director, Head of Medical Affairs, Immunology
  • RBW Consulting
  • Philadelphia, PA
  • A major international pharma business is looking to expands its immunology pipeline and requires a dynamic and forward t...
  • 3/25/2024 12:00:00 AM

To the south and east is the Atlantic Ocean and to the north and northeast is New Brunswick, a province of Canada. The Canadian province of Quebec is to the northwest. Maine is both the northernmost state in New England and the largest, accounting for almost half of the region's entire land area. Maine is the only state in the continental US to border only one other American state (New Hampshire to the South and West). Maine is the easternmost state in the United States in both its extreme points and its geographic center. The town of Lubec is the easternmost organized settlement in the United...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$93,848 to $119,657

Medical Claims Review Manager in Parkersburg, WV
This end-to-end e-billing and e-payment solution is fully integrated with DecisionPoint, which means it can be immediately and easily integrated with your providers, adjusters, IT infrastructure, and claims workflow—enabling you to.
January 01, 2020
Medical Claims Review Manager in Juneau, AK
Examples include a claims examiner’s view of a particular bill’s status in a claim record’s related bill screen, or a bill review analyst’s view of an available reserve amount for the claim record related to the bill they are processing.
December 03, 2019
Medical Claims Review Manager in Galveston, TX
Assists the Manager, Medical Review with performing duties to oversee day-to-day activities within the Medical Claims Review Department to facilitate the achievement of business goals and targets.
December 16, 2019