Medical Claims Review Manager jobs in Rancho Cucamonga, 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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Utilization Review LVN
  • KPC GLOBAL MEDICAL CENTERS INC.
  • Corona, CA FULL_TIME
    • Coordinates and reviews all medical records, as assigned to caseload
    • Actively participates in Case Management and Treatment Team meetings
    • Serves as on-going educator to all departments
    • Responsible for reviewing patient charts in order to assess whether the criteria for admission and continuation of treatment is being met; gathering data and responding to request for records from fiscal intermediary; gathering clinical and fiscal information and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting
    • Able to work independently and use sound judgment.
    • Knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, as well as lower levels of care for the continuity of treatment.
    • Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients, and families.
    • Performs other duties as assigned.
  • 15 Days Ago

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Utilization Review LVN
  • KPC GLOBAL MEDICAL CENTERS INC
  • Corona, CA FULL_TIME
  • Coordinates and reviews all medical records, as assigned to caseloadActively participates in Case Management and Treatment Team meetingsServes as on-going educator to all departmentsResponsible for re...
  • Just Posted

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Workers Compensation Claims Examiner
  • TheBest Claims Solutions
  • Riverside, CA FULL_TIME
  • We are currently sourcing candidates for a Claims Examiner position. This position is direct-hire and remote. For this position we are looking for candidates with 3 years of experience handling Califo...
  • 7 Days Ago

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CA Utilization Review Case Manager I
  • CorVel Brand
  • Rancho Cucamonga, CA FULL_TIME
  • The Utilization Review Case Manager gathers demographic and clinical information on prospective, concurrent and retrospective in-patient admissions and out-patient treatment, certifies the medical nec...
  • 10 Days Ago

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Manager, Claims Processing - Covered California
  • Inland Empire Health Plan
  • Rancho Cucamonga, CA FULL_TIME
  • Overview What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experien...
  • 1 Month Ago

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Assistant Manager/ Medical Assistant
  • Fontana Medical Group
  • Murrieta, CA PART_TIME,FULL_TIME
  • Assistant Manager/ Medical Assistant Must have sales experience: Learn the product we have and sell to patients.Medical Assistant / Based on Experience employment type:Looking for an energetic, outgoi...
  • 25 Days Ago

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0 Medical Claims Review Manager jobs found in Rancho Cucamonga, CA area

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Claims Adjuster - Workers Compensation
  • Sedgwick
  • Rancho Cucamonga, CA
  • **Claims Adjuster - Workers Compensation** **Claims Adjuster - Workers Compensation** **The 'Apply with SEEK' option wil...
  • 4/19/2024 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...
  • 4/18/2024 12:00:00 AM

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Clinical Liaison LVN - Regional Administration
  • Providence Health & Services
  • Rancho Cucamonga, CA
  • The Clinical Liaison position is responsible for creating and maintaining positive customer relationships in order to in...
  • 4/18/2024 12:00:00 AM

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Licensed Vocational Nurse (LVN) Sub-Acute PEDS - Loan Forgiveness & $7,000 Sign-on Bonus - Full Time, Nights (Tustin)
  • Hiring Now!
  • Pomona, CA
  • The Licensed Vocational Nurse performs a wide variety of patient care activities under the direction of registered nursi...
  • 4/17/2024 12:00:00 AM

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Psychiatric Nurse Practitioner - Claremont, CA
  • LifeStance Health
  • Claremont, CA
  • At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make liv...
  • 4/16/2024 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 Imperialfor this reason the difference and plurality of people, equality of oppor...
  • 4/16/2024 12:00:00 AM

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Licensed Vocational Nurse (LVN) - Full-Time, Days (Tustin)
  • Hiring Now!
  • Pomona, CA
  • The Licensed Vocational Nurse performs a wide variety of patient care activities under the direction of registered nursi...
  • 4/16/2024 12:00:00 AM

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HIRING PER DIEM RN/LVN/Certified Home Health Aid
  • Jameco Home Health Agency Inc.
  • Upland, CA
  • Job Description Job Description Benefits/Perks Flexible Scheduling Competitive Compensation Careers Advancement RN- $120...
  • 4/15/2024 12:00:00 AM

Rancho Cucamonga is a city of about 177,000 residents located just south of the foothills of the San Gabriel Mountains and Angeles National Forest in San Bernardino County, California, United States. About 37 miles (60 km) east of Downtown Los Angeles, Rancho Cucamonga is the 19th most populous city in southern California and the 27th state-wide. The city's seal, which centers on a cluster of grapes, alludes to the city's agricultural history including wine-making. The city's proximity to major transportation hubs, airports, and highways has attracted the business of several large corporations...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$103,133 to $131,497
Rancho Cucamonga, California area prices
were up 3.0% 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