Medical Claims Review Manager jobs in Sunnyvale, 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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Institutional Review Board (IRB) Manager
  • Stanford University
  • Sunnyvale, CA FULL_TIME
  • Who are we?

    The Research Compliance Office (RCO) is responsible for oversight and management of Stanford's Administrative (Compliance) Panels and ensures compliance with applicable policies, accreditation standards and external regulations. Our goal at RCO is to help facilitate research and to make sure it is done safely, ethically, and legally. We take pride in being service-oriented.

    Stanford University's IRB is charged with ensuring that all aspects of Stanford's Human Research Protection Program comply with all applicable laws, regulations, and policies, including standards of excellence necessary for maintaining accreditation status. This position, which is core to Stanford's research compliance activities, focuses primarily with medical Research.

    We are seeking a candidate experienced with regulatory compliance and institutional review boards (IRBs) and that has excellent customer service skills.

    Our VPDoR Diversity Journey:
    • We create a hub of innovation through the power of diversity of disciplines and people.
    • We provide equitable access and opportunity to all members of the community in order to do their best work, regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law.
    • We listen to and value all colleagues who bring diverse perspectives to the advancement and development of a respectful community.
    • We promote a culture of belonging, equity, and safety.
    • We embed these values in excellence of education, research, and operation.

    POSITION SUMMARY:

    In this position, under the direction of the Associate Director and the IRB Chair, you will conduct in-depth protocol review using advanced regulatory knowledge and experience. The primary responsibility will be to manage the protocol review process and identify issues, and to independently determine whether the components of the proposed research are in compliance with federal, state and local regulations, Stanford University policies, and accreditation standards. You will also be involved in:
    • Developing, implementing, and managing efficient procedures to facilitate the processing of human protocols in accordance with Stanford, federal, accreditation, and state policies and procedures.
    • Performing review of complex research protocols, including identifying problems and issues in the submission application and contacting the investigator orally or in writing to request additional materials.
    • Planning and coordinating IRB review and follow-up activities.
    • Serving as an expert liaison between the research investigator and the reviewer; educate parties on relevant and emerging regulations and related risk management issues.
    • Applying knowledge of federal, state, and local regulations, as well as university policies and practices, to ensure satisfactory compliance.
    • Providing assistance to management in preparation for accreditation and in various compliance and quality assurance activities.

    *Please note this position may require the following:
    • Occasional work on evenings and weekends or on-standard hours based on project or business needs.
    • Occasional cross campus and local travel
    • Exposure to allergens, biohazards, chemicals, radiation, or electromagnetic fields.

    This is a 100% FTE, benefits-eligible position. For consideration, please submit your resume. All final candidates must complete a background check.

    This position has the potential to be a hybrid work role - a combination of onsite work and telecommuting - based on business and operational needs.

    To be successful in this position, you will bring:
    • Bachelor's degree and three years of relevant experience, or combination of education and relevant experience.
    • Comprehensive knowledge of regulatory information regarding the use of human/animal participation in research and teaching.
    • Demonstrated understanding of the principles of human/animal research protection standards.
    • Strong knowledge of grants and contracts function. Significant working knowledge of research procedures and terminology, medical terminology, clinical trials, and research data management.
    • In-depth understanding of operational requirements pertaining to management and implementation of protocol process.
    • Demonstrated strong verbal and written communication skills. Knowledge of human/animal subjects and Stanford, federal and state policies and procedures.
    • Knowledge of research procedures and terminology, medical terminology, clinical trials, and research data management.

    MINIMUM REQUIREMENTS:

    Education & Experience:

    Bachelor's degree and three years of relevant experience, or combination of education and relevant experience.

    In addition, our preferred requirements include:
    • Institutional Review Board professional certification desirable.
    PHYSICAL REQUIREMENTS*:
    • Frequently perform desk-based computer tasks, seated work and use light/ fine grasping.
    • Occasionally stand, walk, and write by hand, lift, carry, push pull objects that weigh up to 10 pounds.
    * - Consistent with its obligations under the law, the University will provide reasonable accommodation to any employee with a disability who requires accommodation to perform the essential functions of the job.

    WORK STANDARDS:
    • Interpersonal Skills: Demonstrates the ability to work well with Stanford colleagues and clients and with external organizations.
    • Promote Culture of Safety: Demonstrates commitment to personal responsibility and value for safety; communicates safety concerns; uses and promotes safe behaviors based on training and lessons learned.
    • Subject to and expected to comply with all applicable University policies and procedures, including but not limited to the personnel policies and other policies found in the University's Administrative Guide, http://adminguide.stanford.edu.

    The expected pay range for this position is $100,000 to $133,000 per annum.
    Stanford University provides pay ranges representing its good faith estimate of what the university reasonably expects to pay for a position. The pay offered to a selected candidate will be determined based on factors such as (but not limited to) the scope and responsibilities of the position, the qualifications of the selected candidate, departmental budget availability, internal equity, geographic location and external market pay for comparable jobs.

    At Stanford University, base pay represents only one aspect of the comprehensive rewards package. The Cardinal at Work website (https://cardinalatwork.stanford.edu/benefits-rewards) provides detailed information on Stanford's extensive range of benefits and rewards offered to employees. Specifics about the rewards package for this position may be discussed during the hiring process.

    Why Stanford is for You

    Imagine a world without search engines or social platforms. Consider lives saved through first-ever organ transplants and research to cure illnesses. Stanford University has revolutionized the way we live and enrich the world. Supporting this mission is our diverse and dedicated 17,000 staff. We seek talent driven to impact the future of our legacy. Our culture and unique perks empower you with:
    • Freedom to grow. We offer career development programs, tuition reimbursement, or audit a course. Join a TedTalk, film screening, or listen to a renowned author or global leader speak.
    • A caring culture. We provide superb retirement plans, generous time-off, and family care resources.
    • A healthier you. Climb our rock wall, or choose from hundreds of health or fitness classes at our world-class exercise facilities. We also provide excellent health care benefits.
    • Discovery and fun. Stroll through historic sculptures, trails, and museums.
    • Enviable resources. Enjoy free commuter programs, ridesharing incentives, discounts and more!

    The job duties listed are typical examples of work performed by positions in this job classification and are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Specific duties and responsibilities may vary depending on department or program needs without changing the general nature and scope of the job or level of responsibility. Employees may also perform other duties as assigned.

    Stanford is an equal employment opportunity and affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law.

    #PLPandoLogic. Keywords: Institutional Review Board (IRB) Manager, Location: Sunnyvale, CA - 94086

    About the Company:
    Stanford University



  • 1 Month Ago

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Institutional Review Board (IRB) Manager
  • Stanford University
  • N/A, CA FULL_TIME
  • Who are we?The Research Compliance Office (RCO) is responsible for oversight and management of Stanford's Administrative (Compliance) Panels and ensures compliance with applicable policies, accreditat...
  • 1 Month Ago

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Institutional Review Board (IRB) Manager
  • Stanford University
  • Fremont, CA FULL_TIME
  • Who are we?The Research Compliance Office (RCO) is responsible for oversight and management of Stanford's Administrative (Compliance) Panels and ensures compliance with applicable policies, accreditat...
  • 1 Month Ago

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Supplier Claims Manager
  • Lucid Motors
  • Newark, CA FULL_TIME
  • We are seeking a highly skilled and organized Supplier Claims Manager to join our team at Lucid Motors. In this crucial role, you will be responsible for managing and overseeing the supplier claims pr...
  • 18 Days Ago

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RWSHR - Conference Services Manager
  • Conference Services Manager
  • Menlo, CA FULL_TIME
  • OVERVIEW/BASIC FUNCTION: Under the supervision of the Director of Catering is responsible for all aspects and functions of the Conference Services in accordance with Hotel standards. Coordinates arran...
  • 19 Days Ago

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Global FP&A Sr. Manager - Strategic Review and Enterprise Portfolio
  • Applied Materials, Inc
  • Santa Clara, CA FULL_TIME
  • This leadership role under Global FP&A will support the Enterprise Portfolio Process and financial analysis/reporting for the annual Strategic Planning process at the company. This position will invol...
  • 1 Month Ago

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

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Global Medical Affairs Lead (Pathology)
  • Agilent Technologies, Inc.
  • Santa Clara, CA
  • The Medical Affairs Director (C - Dx/ Pathology) will work closely with and report to the Global Head of Medical Affairs...
  • 4/19/2024 12:00:00 AM

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Head of Engineering | Next Gen Biosensor/Proteomics Start-Up | Report to Founder/CEO | San Francisco-based | Retained Search
  • Cornerstone Search Group
  • Head of Engineering | Next Gen Biosensor/Proteomics Start-Up | Report to Founder/CEO | San Francisco-based | Retained Se...
  • 4/18/2024 12:00:00 AM

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Executive Director/ Sr. Director of Medical Affairs
  • Adicet Bio, Inc.
  • Redwood City, CA
  • JOIN US! Adicet Bio, Inc. is a clinical stage biotechnology company discovering and developing allogeneic gamma delta T ...
  • 4/18/2024 12:00:00 AM

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Host
  • Romano's Macaroni Grill
  • Milpitas, CA
  • The Hosts role is to provide a "Guest First" service at all times, making the Guest the heart and passion of all they do...
  • 4/18/2024 12:00:00 AM

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Remote Licensed Alcohol and Drug Counselor (LADC-I) - Massachusetts
  • Headway
  • San Jose, CA
  • Are you a Licensed Alcohol and Drug Counselor (LADC-I) in Massachusetts in South Dakota looking to launch a private prac...
  • 4/18/2024 12:00:00 AM

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Remote Licensed Addiction Counselor (LAC) - Colorado
  • Headway
  • San Jose, CA
  • Are you a Licensed Addiction Counselor (LAC) in Colorado in South Dakota looking to launch a private practice, or grow y...
  • 4/18/2024 12:00:00 AM

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Remote License Professional Counselor of Mental Health (LPCMH)
  • Headway
  • San Jose, CA
  • Are you a License Professional Counselor of Mental Health (LPCMH) in South Dakota in South Dakota looking to launch a pr...
  • 4/18/2024 12:00:00 AM

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Med Technician
  • ABIGAIL COMPLETE CARE INC
  • Redwood City, CA
  • Job Description Job Description We are seeking a Med Technician to join our team! You will be responsible for monitoring...
  • 4/17/2024 12:00:00 AM

Sunnyvale (/ˈsʌniveɪl, vəl/) is a city located in Santa Clara County, California. As of the 2010 United States Census, the population was 140,095. Sunnyvale is the seventh most populous city in the San Francisco Bay Area and one of the major cities comprising Silicon Valley. It is bordered by portions of San Jose to the north, Moffett Federal Airfield to the northwest, Mountain View to the northwest, Los Altos to the southwest, Cupertino to the south, and Santa Clara to the east. It lies along the historic El Camino Real and Highway 101. As part of California's high-tech area known as Silicon ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$122,453 to $156,129
Sunnyvale, California area prices
were up 2.9% 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