Medical Claims Review Manager jobs in Tennessee

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 MANAGER - BJIT
  • Williamson Medical Center
  • FRANKLIN, TN FULL_TIME
  • Located in Franklin, Tennessee, Williamson Health is one of the South’s most exceptional health care systems with a 203 bed hospital (Williamson Medical Center), over 40 providers at our Williamson Health Medical Group locations, the Bone & Joint Institute and the Monroe Carell Junior Children’s Hospital Vanderbilt at Williamson Medical Center.  Williamson Health offers comprehensive in-patient and out-patient services. We have more than 825 providers representing over 70 medical specialties and sub-specialties. 

    Williamson Health is a system where your talents will be valued and your skillset expanded. We are rooted in our promise to world-class, compassionate care for the residents of Williamson County and surrounding communities, taking exceptional pride in serving our community. We’re committed to empowering our employees to work in innovative ways and reserve time and space for curiosity, laughter and creativity. We value and support the diversity and cultural differences among one another and are committed to upholding an inclusive environment that appreciates the uniqueness of all individuals. Our values are at the heart of everything we do: respect for every individual, the health and total well-being of all people, human compassion and integrity. These shape who we are as an organization and are essential for delivering the highest level of culturally competent care and treatment of every patient, family member, visitor, physician and employee.

    Williamson Health is pleased to offer a comprehensive benefits program, that offers you choice and flexibility, so you can take charge of your physical, financial, and emotional well-being. 
    o    Medical, Dental, Vision
    o    PTO
    o    Retirement Matching
    o    Tuition reimbursement
    o    Discount programs
    o    FSA (Flexible Spending Accounts)
    o    Identity Theft Protection
    o    Legal Aid

    Williamson Health is an equal-opportunity employer and a drug-free workplace.

    POSITION SUMMARY

    Responsible for daily management and oversight of the following departments: Test and Surgery Scheduling, Worker’s Compensation and Utilization Review. Assists the Director of Operations as directed and needed. For purposes of evaluations and attendance, this position reports to the Director of Operations.

    POSITION REQUIREMENTS

    Formal Education/Training:
    Bachelor’s Degree preferred in Business, Healthcare Administration or related field; or equivalent experience.


    Workplace Experience:
    At least three years of supervisor or higher experience in a medical practice. Billing/collections, front and back-office procedures/policies experience preferred. Demonstrate leadership and good interpersonal skills.


    Equipment and Skills Training:
    Strong Computer Skills, Communication and Presentation Skills required. Demonstrated ability to self-direct, meet deadlines and support Physician Groups.


    Physical Environment:
    Physician and Clinical setting/environment.


    Physical Effort:
    Requires the ability to communicate proficiently; oral and written. Requires prolonged standing and working up to twelve hours if needed. Requires the ability to lift minimal amounts (20-25 lbs).

    PERFORMANCE STANDARDS

    1. Maintains administrative functions for Test and Surgery Scheduling, Worker’s Compensation and Utilization Review department operations and assists in organizing departmental, interdepartmental, and other meetings/events as needed.
    2. Facilitates staff development, assists with the orientation and training of new department personnel, ongoing educational programs, regularly scheduled touchpoints, and staff evaluations (90 day and annual).
    3. Acts as liaison to support staff and patients by responding to assistance needs; including working in departments to cover vacations/absences when needed or requested by the Director of Operations.
    4. Serves as principal contact for clinic staff regarding prior authorization processes for services to be rendered by BJIT providers, by maintaining a current knowledge base related to insurance requirements for prior authorization.
    5. Develop procedures for prior authorization and denial management functions.
    6. Serves as liaison between BJIT surgeons and outside surgical facilities.
    7. Maintains accurate and appropriate payroll reporting and staff scheduling for all direct reports, including reviewing incoming employee applications and position postings. Arranges interviews in conjunction with HR in order to hire new employees as needed.
    8. Improves performance with regard to patient/employee satisfaction scores. Consistently meets or exceeds KPI’s set for assigned departments.
    9. Reports completely and accurately any incident that may warrant review by manager/physician.
    10. Maintains open line of communication with all staff members; interacts with staff/patients in a professional and constructive manner.
    11. Reports concerns requiring attention to other managers or Director of Operations. Employee is a problem solver that brings possible solutions when presenting concerns or problems and responds to patient/staff complaints in a timely manner.
    12. Participates in departmental meetings/huddles/etc. and recommends improvement opportunities. Performs other duties as assigned by Director of Operations.
       
  • 23 Days Ago

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Medical Record Review Coordinator
  • DCI Donor Services
  • Nashville, TN FULL_TIME
  • DCI Donor Services (DCIDS) is looking for a dynamic and enthusiastic team member to join us to save lives!! Our mission at DCIDS is to save lives through organ donation and we want professionals on ou...
  • 1 Month Ago

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UTILIZATION REVIEW MANAGER - BJIT
  • BJIT in FRANKLIN, TN - Williamson Health
  • FRANKLIN, TN FULL_TIME
  • Summary Located in Franklin, Tennessee, Williamson Health is one of the South’s most exceptional health care systems with a 203 bed hospital (Williamson Medical Center), over 40 providers at our Willi...
  • 23 Days Ago

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Manager of Utilization Review
  • Charlie Health Behavioral Health Operations
  • Nashville, TN FULL_TIME
  • About the Role Utilization review is at the core of Charlie Health’s mission and allows us to serve more clients better, faster. As such, the UR Manager plays an integral part in onboarding and traini...
  • 2 Months Ago

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UTILIZATION REVIEW MANAGER - BJIT
  • Williamson Health
  • Franklin, TN FULL_TIME
  • SummaryLocated in Franklin, Tennessee, Williamson Health is one of the South's most exceptional health care systems with a 203 bed hospital (Williamson Medical Center), over 40 providers at our Willia...
  • 16 Days Ago

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Claims System Configuration Quality Review Senior Analyst - eviCore - Remote
  • The Cigna Group
  • Franklin, TN OTHER,FULL_TIME
  • The job profile for this position is Operations Senior Analyst, which is a Band 3 Senior Contributor Career Track Role.Excited to grow your career?We value our talented employees, and whenever possibl...
  • 7 Days Ago

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Head of Medical Writing
  • Morgan Prestwich - Life Science & Healthcare Executive Search
  • Company Overview Morgan Prestwich is thrilled to be representing our client on an exclusive basis. Our client is a clini...
  • 3/29/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Orem, UT
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/28/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Fairfield, CA
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/28/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Folsom, CA
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/28/2024 12:00:00 AM

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Medical Lead - Oncology, Medical Affairs
  • SEC Life Sciences
  • One of the world's leading pharmaceutical companies is seeking four passionate, forward-thinking individuals for key rol...
  • 3/28/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco
  • Menifee, CA
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/27/2024 12:00:00 AM

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Medication Management Associate
  • Fresenius Medical Care
  • Bluffton, IN
  • PURPOSE AND SCOPE: Promotes quality patient care, ongoing customer support and case management for Fresenius Medical Car...
  • 3/27/2024 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...
  • 3/25/2024 12:00:00 AM

Tennessee borders eight other states: Kentucky and Virginia to the north; North Carolina to the east; Georgia, Alabama, and Mississippi on the south; Arkansas and Missouri on the Mississippi River to the west. Tennessee is tied with Missouri as the state bordering the most other states. The state is trisected by the Tennessee River. The highest point in the state is Clingmans Dome at 6,643 feet (2,025 m). Clingmans Dome, which lies on Tennessee's eastern border, is the highest point on the Appalachian Trail, and is the third highest peak in the United States east of the Mississippi River. The ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$89,496 to $114,109

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