Medical Claims Review Manager jobs in Pasadena, 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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RN Case Manager - Utilization Review
  • St. Francis Medical Center
  • Lynwood, CA FULL_TIME
  • Overview

    Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! St. Francis Medical Center, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.

    St. Francis Medical Center is one of the leading comprehensive healthcare institutions serving Southeast Los Angeles. St. Francis is dedicated to providing vital healthcare services for the 700,000 adults and 300,000 children who count on the hospital for high quality and compassionate medical care. St. Francis is recognized for its full range of diagnostic and treatment services in specialties including Cardiovascular, Surgical, Orthopedics, Maternal-Child Health, Behavioral Health and Emergency and Trauma Care.  In addition, the hospital offers a broad array of education and outreach programs that advance community health. St. Francis Medical Center is a Certified Primary Stroke Center, Approved STEMI Receiving Center for Los Angeles County and designated Baby-Friendly healthcare facility by Baby-Friendly USA. Please visit www.stfrancismedicalcenter.comfor more information.

     

    We are an Equal Opportunity Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation, or other protected characteristics.  If you need special accommodation for the application process, please contact Human Resources.  Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

    Responsibilities

    Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management. Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.

    Qualifications

    EDUCATION, EXPERIENCE, TRAINING

     

    1. Starting April 1 2015. Minimum 5 years work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum 5 years post graduate of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care nursing experience preferred. At least one year experience in case management, discharge planning or nursing management, preferred.4. Current BCLS (AHA) certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred.6. Experience and knowledge in basic to intermediate computer skills.

     

     

    St. Francis Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. Benefits may vary based on collective bargaining agreement requirements and/or the employment status, i.e. full-time or part-time. The current compensation range for this role is $41.37 to $59.60. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

  • 1 Month Ago

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Claims Review Specialist - Accounting
  • Ampcus, Inc
  • Los Angeles, CA FULL_TIME
  • Must have High school diploma, GED or equivalent required, Two year degree preferred. Minimum of 3 years previous experience working for a Health Plan, IPA, or other Managed Care Organization. Minimum...
  • 22 Days Ago

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Travel Nurse RN - Case Manager, Utilization Review - $2,285 per week
  • Medical Solutions
  • Glendale, CA FULL_TIME
  • Medical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Glendale, California.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: ...
  • 15 Days Ago

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Medical Record Review Specialist
  • Codemax Medical Billing
  • Van Nuys, CA FULL_TIME
  • Position: Medical Record Review Specialist Reports To: Medical Records Department Supervisor Employment Status: Full-Time FLSA Status: Non-Exempt Job Summary: The Medical Record Review Specialist is r...
  • 20 Days Ago

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Claims Review Specialist - Accounting/ Revenue Integrity Analyst
  • Ampcus, Inc
  • Los Angeles, CA FULL_TIME
  • REQUIRED EXPERIENCE: Take on a significant role within a world-class health organization. Elevate the operational and financial effectiveness of a complex health system. Take your professional experti...
  • 7 Days Ago

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Data Entry Associate
  • Advanced Medical Review
  • Culver, CA OTHER
  • Overview You put the pro in data entry professional. You’ve got problem-solving instincts, a passion for helping people, and the technical training to deliver results. You’re also looking for great be...
  • 8 Days Ago

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0 Medical Claims Review Manager jobs found in Pasadena, CA area

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Licensed Vocational Nurse (LVN) Med/Surg - Loan Forgiveness & $7,000 Sign-on Bonus - Full Time, Nights (LACH)
  • Alta Hospitals
  • Los Angeles, CA
  • The Licensed Vocational Nurse performs a wide variety of patient care activities under the direction of registered nursi...
  • 3/27/2024 12:00:00 AM

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Nurse Manager Surgery
  • Clinical Management Consultants
  • Pasadena, CA
  • A very highly accredited acute care hospital in Southern California is looking to bring on a new Nurse Manager Surgery t...
  • 3/26/2024 12:00:00 AM

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Licensed Vocational Nurse (Med/Surg) - Loan Forgiveness & $7,000 Sign-on Bonus - Full Time, Nights (LACH)
  • Alta Hospitals
  • Los Angeles, CA
  • The Licensed Vocational Nurse performs a wide variety of patient care activities under the direction of registered nursi...
  • 3/26/2024 12:00:00 AM

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Psychiatric Nurse Practitioner - Pasadena, CA
  • LifeStance Health
  • Pasadena, CA
  • At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make liv...
  • 3/25/2024 12:00:00 AM

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Psychiatric Nurse Practitioner - Pasadena, CA
  • LifeStance Health
  • Pasadena, CA
  • At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make liv...
  • 3/25/2024 12:00:00 AM

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Child and Adolescent Psychiatric Mental Health Nurse Practitioner - Remote
  • Foresight Mental Health
  • Pasadena, CA
  • Welcome to Foresight Mental Health. Join a team with purpose! At Foresight Mental Health, we are committed to supporting...
  • 3/25/2024 12:00:00 AM

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Front/Back Office Assistant
  • Candy Medical Management
  • Hermosa Beach, CA
  • Job Description Job Description Pier Medical Aesthetics/ Candy Medical Mgmt is hiring a part-time to grow to full-time f...
  • 3/25/2024 12:00:00 AM

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Licensed Vocational Nurse (Med/Surg) - Loan Forgiveness & $7,000 Sign-on Bonus - Full Time, Nights (Los Angeles)
  • Alta Hospitals
  • Los Angeles, CA
  • The Licensed Vocational Nurse performs a wide variety of patient care activities under the direction of registered nursi...
  • 3/24/2024 12:00:00 AM

Pasadena is a city in Los Angeles County, California, United States, located 10 miles (16 kilometers) northeast of Downtown Los Angeles. The estimated population of Pasadena was 142,647 in 2017, making it the 183rd-largest city in the United States. Pasadena is the ninth-largest city in Los Angeles County. Pasadena was incorporated on June 19, 1886, becoming one of the first cities to be incorporated in what is now Los Angeles County, following the city of Los Angeles (April 4, 1850). It is one of the primary cultural centers of the San Gabriel Valley. The city is known for hosting the annua...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$109,298 to $139,356
Pasadena, California area prices
were up 3.2% 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