Medical Claims Review Manager jobs in Riverside, 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.
  • 21 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...
  • 6 Days Ago

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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...
  • 13 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...
  • 16 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...
  • 1 Month Ago

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

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Sharp Rees Stealy -RN-Triage -SRS Pediatrics - Float Pool - San Diego Main - Per Diem- Day Shift
  • Sharp Healthcare
  • Riverside, CA
  • Hours Shift Start Time: 8 AM Shift End Time: 5 PM Additional Shift Information: Hours may vary based on clinic need Week...
  • 4/24/2024 12:00:00 AM

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Sharp Rees Stealy - RN - Float Pool-Specialties - Per Diem - Variable Days
  • Sharp Healthcare
  • Riverside, CA
  • Hours Shift Start Time: Variable Shift End Time: Variable Additional Shift Information: Variable hours: 7am-8:30pm *info...
  • 4/24/2024 12:00:00 AM

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SRS - RN - Oncology - Frost Street - Full Time - Day Shift
  • Sharp Healthcare
  • Riverside, CA
  • Hours Shift Start Time: 7:30 AM Shift End Time: 5 PM Additional Shift Information: am/pm hours variable Weekend Requirem...
  • 4/23/2024 12:00:00 AM

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Sharp Rees Stealy - Urology -Triage RN - Full Time - Day Shift
  • Sharp Healthcare
  • Riverside, CA
  • Hours Shift Start Time: 8 AM Shift End Time: 5 PM Additional Shift Information: Weekend Requirements: No Weekends On-Cal...
  • 4/23/2024 12:00:00 AM

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Sharp Rees Stealy - Occ Med - RN - Per Diem - Day Shift
  • Sharp Healthcare
  • Riverside, CA
  • Hours Shift Start Time: Shift End Time: Additional Shift Information: Weekend Requirements: On-Call Required: No Hourly ...
  • 4/23/2024 12:00:00 AM

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Sharp Rees Stealy - Ob/GYN RN-Triage- Full Time - Day Shift
  • Sharp Healthcare
  • Riverside, CA
  • Hours Shift Start Time: 8:30 PM Shift End Time: 5 PM Additional Shift Information: Weekend Requirements: No Weekends On-...
  • 4/23/2024 12:00:00 AM

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Outpatient Child Psychiatrist - Hybrid schedule - Riverside, CA
  • LifeStance Health
  • Riverside, CA
  • At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make liv...
  • 4/22/2024 12:00:00 AM

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Adult Psychiatrist - Riverside, CA
  • LifeStance Health
  • Riverside, CA
  • At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make liv...
  • 4/22/2024 12:00:00 AM

Riverside is a city in Riverside County, California, United States, located in the Inland Empire metropolitan area. Riverside is the county seat of the eponymous county and named for its location beside the Santa Ana River. It is the most populous city in the Inland Empire and in Riverside County, and is located about 55 miles (89 km) east of downtown Los Angeles. It is also part of the Greater Los Angeles area. Riverside is the 59th most populous city in the United States and 12th most populous city in California. As of the 2010 Census, Riverside had a population of 303,871. Riverside was fou...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$103,719 to $132,243
Riverside, 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