Medical Claims Review Manager jobs in Temecula, 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.
  • 16 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...
  • 1 Day 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...
  • 8 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...
  • 11 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...
  • 26 Days Ago

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

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Remote Licensed Psychiatric Nurse Practitioner
  • Hiring Now!
  • Temecula, CA
  • Remote Licensed Psychiatric Nurse Practitioner Wage: Between $144-$222 an hour Are you a licensed Psychiatric Nurse look...
  • 4/19/2024 12:00:00 AM

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Remote Licensed Psychiatric Nurse Practioner
  • Hiring Now!
  • Temecula, CA
  • Remote Licensed Psychiatric Nurse Practitioner Wage: Between $203 - $269 an hour Are you a licensed Psychiatric Nurse lo...
  • 4/18/2024 12:00:00 AM

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Remote Licensed Psychiatrist
  • Headway
  • Temecula, CA
  • Remote Licensed Psychiatrist Wage: Between $148-$232 an hour Are you a licensed Psychiatrist looking to launch a private...
  • 4/16/2024 12:00:00 AM

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Remote Licensed Clinical Social Worker
  • Headway
  • Temecula, CA
  • Remote Licensed Clinical Social Worker (LCSW) Wage: Between $86-$130 an hour Are you a Licensed Clinical Social Worker l...
  • 4/16/2024 12:00:00 AM

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Remote Licensed Mental Health Counselor
  • Headway
  • Temecula, CA
  • Remote Licensed Mental Health Counselor (LMHC) Wage: Between $86-$130 an hour Are you a Licensed Mental Health Counselor...
  • 4/16/2024 12:00:00 AM

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Remote Licensed Mental Health Therapist
  • Headway
  • Temecula, CA
  • Remote Licensed Mental Health Therapist (LMHT) Wage: Between $86-$130 an hour Are you a Licensed Mental Health Therapist...
  • 4/16/2024 12:00:00 AM

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Remote Licensed Psychiatric Nurse Practitioner
  • Headway
  • Temecula, CA
  • Remote Licensed Psychiatric Nurse Practitioner Wage: Between $144-$222 an hour Are you a licensed Psychiatric Nurse look...
  • 4/16/2024 12:00:00 AM

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Licensed Vocational Nurse (Home Health) - Menifee, CA
  • Neogen Care
  • Menifee, CA
  • Join Our Team of Highly Talented and Committed Clinical Professionals * Founded in 2014 in San Francisco Bay Area, Neoge...
  • 4/16/2024 12:00:00 AM

Temecula /təˈmɛkjʊlə/ is a city in southwestern Riverside County, California, United States. The city is a tourist destination, with the Temecula Valley Wine Country, Old Town Temecula, the Temecula Valley Polo Club, the Temecula Valley Balloon & Wine Festival, the Temecula Valley International Film Festival, championship golf courses, and resort accommodations for tourists which contribute to the city's economic profile. The City of Temecula, forming the southwestern anchor of the Inland Empire region, is approximately 58 miles (93 km) north of downtown San Diego and 85 miles (137 km) southea...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$104,207 to $132,865
Temecula, 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