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Medical Claims Review Manager jobs in Oregon

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

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Case Manager - Utilization Review - Surgery Specialist
  • McKenzie-Willamette Medical Center
  • Springfield, OR FULL_TIME

  • Hourly Base Rate: $32.15 - $48.05
    Shift: Day Shift
    Hours Per Week: 40-hours
    Date Posted: 3/22/2024

    Job Summary:

    • Analyzes patient records to determine legitimacy of admission, treatment, and length of stay in health-care facility to comply with government and insurance company reimbursement policies: Analyzes insurance, governmental, and accrediting agency standards to determine criteria concerning admissions, treatment, and length of stay of patients.
    • Reviews application for patient admission and approves admission or refers case to facility utilization review committee for review and course of action when case fails to meet admission standards.
    • Compares inpatient medical records to established criteria and confers with medical and nursing personnel and other professional staff to determine legitimacy of treatment and length of stay.
    • Abstracts data from records and maintains

    Educational/Licensure:

    • Current Oregon RN license
    • Knowledge in areas such as InterQual Level of Care Criteria and Milliman & Robertson Criteria as well as knowledge of third party payer regulations related to utilization and quality review is also preferred.

    Qualifications:

    • Significant experience in the healthcare field is required including a minimum of five years as a clinical nurse in an acute care setting. In addition, having at least five to seven years of experience in case management, discharge planning, and/or utilization review is preferred.
    • Knowledge of regulatory and payer requirements for Case Management Activities.
    • Ability to critically evaluate and make decisions about whether discharge planning for highly difficult cases.

    Education

    Preferred
    • Bachelors or better in Nursing

    Licenses & Certifications

    Required
    • L-OR-RN License
  • 24 Days Ago
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Senior Claims Insurance Manager - Medical Professional Liability Claims *Remote
  • Providence Health
  • Oregon, OR FULL_TIME
  • Description Providence caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutu...
  • 1 Month Ago
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Claims Manager
  • HCLTech
  • Remote, OR FULL_TIME
  • 9 - 12 Years Healthcare experience must9 - 12 years of experience in US Healthcare Payor operation.Including, 7-10 years of experience in managing teams, Strong operational & people management skill w...
  • 7 Days Ago
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Medical Claims Processor I
  • Moda Health
  • Remote, OR FULL_TIME
  • Let’s do great things, together Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare...
  • 13 Days Ago
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Medical Claims COB Processor
  • Moda Health
  • Portland, OR FULL_TIME
  • Let’s do great things, together! Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcar...
  • 2 Days Ago
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Medical Claims Support I
  • Moda Health
  • Milwaukie, OR FULL_TIME
  • Let’s do great things, together! Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcar...
  • 1 Month Ago
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Medical Claims Review Manager jobs at Popular Companies

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Head of Medical Writing
  • Proclinical Staffing
  • Head of Medical Writing - Permanent - Onsite Proclinical is seeking a Head of Medical Writing to join a cutting-edge bio...
  • 4/17/2024 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...
  • 4/16/2024 12:00:00 AM
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Head of Medical Writing
  • Aerovate Therapeutics, Inc.
  • Waltham, MA
  • Aerovate (AVTE) is a clinical stage biopharmaceutical company focused on developing drugs that meaningfully improve the ...
  • 4/15/2024 12:00:00 AM
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Senior Director, Global Pharmacovigilance & Risk Management Head of Medical Safety
  • Vir Biotechnology, Inc.
  • Vir Biotechnology, Inc. is an immunology company focused on combining cutting-edge technologies to treat and prevent inf...
  • 4/15/2024 12:00:00 AM
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Executive Director, Medical Lead, Immuno-Oncology Clinical Development
  • Astellas Pharma, Inc.
  • Northbrook, IL
  • Job Description Do you want to be part of an inclusive team that works to develop innovative therapies for patients? Eve...
  • 4/15/2024 12:00:00 AM
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Regional Medical Lead - West
  • HeartFlow
  • Dallas, TX
  • HeartFlow, Inc. is a medical technology company advancing the diagnosis and management of coronary artery disease, the #...
  • 4/14/2024 12:00:00 AM
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Technologist-Medical Lead - MG Diagnostic Lab BMG
  • Baptist Memorial
  • Germantown, TN
  • Summary Perform all functions of the Medical Technologist and supervise the personnel and activities of various sections...
  • 4/13/2024 12:00:00 AM
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Medical Director, Medical Management
  • Imperial Health Plan of California, Inc.
  • Pasadena, CA
  • People are the most important asset of Imperial, for this reason the difference and plurality of people, equality of opp...
  • 4/13/2024 12:00:00 AM
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About Oregon

Oregon (/ˈɒrɪɡən/ (listen) ORR-ih-gən) is a state in the Pacific Northwest region on the West Coast of the United States. The Columbia River delineates much of Oregon's northern boundary with Washington, while the Snake River delineates much of its eastern boundary with Idaho. The parallel 42° north delineates the southern boundary with California and Nevada. Oregon is one of only four states of the continental United States to have a coastline on the Pacific Ocean. Oregon was inhabited by many indigenous tribes before Western traders, explorers, and settlers arrived. An autonomous government ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$99,133 to $126,396

Most Popular Cities in Oregon for Medical Claims Review Manager Jobs

What does a Medical Claims Review Manager do?

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