Medical Claims Review Manager jobs in Vermont

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)

U
Utilization Review Nurse
  • University of Vermont Medical Center
  • Colchester, VT FULL_TIME
    Job Details
    Job Ref:
    R0064990
    Category:
    Registered Nurse
    Employment Type:
    Full Time
    Location:
    1110 Prim Rd, Colchester, VT
    Department:
    CVMC - Care Management
    Job Type:
    Regular
    Primary Shift:
    Day
    Hours:
    7:30 AM - 4:00 AM
    Hours per Week:
    40
    Weekend Needs:
    None
    Pay Rate:
    $31.43 - $47.14 per hour

    POSITION SUMMARY
    The Utilization Review Nurse is responsible for ensuring the medical necessity and appropriate level of care of all hospital admissions and extended hospital stays, including psychiatry; affirming compliance with CMS' Conditions of Participation regarding Utilization Management with annual review of the UM Plan and assisting with the coordination of the Utilization Management Committee; Knowledge of CMS policy, guidance and criteria as well as those of various managed care insurance plans.

    MINIMUM REQUIREMENTS
    State of Vermont Registered Nurse (RN) license required. The University of Vermont Health Network is moving toward an all Bachelor of Science in Nursing (BSN) workforce.


    PRIOR EXPERIENCE
    3-5 years acute care hospital nurse and/or
    3-5 years chart review, prior authorizations, managed care, familiarity of clinical documentation requirements


    The UVM Health Network is dedicated to creating a workplace that is diverse, equitable, accessible, and inclusive for our employees, patients and communities we serve. This commitment will be included in all strategies and policies and will represent who we are as an organization.

     

  • 10 Days Ago

N
Claims Team Manager
  • National Life Group
  • Montpelier, VT FULL_TIME
  • Claims Team Manager National Life Group At National Life, do work that matters in a culture where people matter. Join a growing organization where our people have been bringing peace of mind to famili...
  • 5 Days Ago

P
Paid Product Tester
  • Product Review Jobs
  • East Wallingford, VT FULL_TIME
  • Compensation: Varies per assignment. Up to $500 per week.Location: Remote (USA)Company: ProductReviewJobsThank you for your interest in becoming a Paid Product Tester. This opportunity is for completi...
  • 14 Days Ago

P
Paid Product Tester
  • Product Review Jobs
  • GUILDHALL, VT FULL_TIME
  • Compensation: Varies per assignment. Up to $500 per week.Location: Remote (USA)Company: ProductReviewJobsThank you for your interest in becoming a Paid Product Tester. This opportunity is for completi...
  • 15 Days Ago

E
General Manager
  • Essex Junction Fast Food General Manager
  • Junction, VT FULL_TIME
  • Job Overview: We are seeking a highly motivated and experienced General Manager with fast food experience to oversee our operations. The General Manager will be responsible for managing all aspects of...
  • 14 Days Ago

N
Account Services Review Specialist
  • New England Federal Credit Union
  • South Burlington, VT FULL_TIME
  • Position: Account Services Review Specialist Location: 88 Technology Park Way, South Burlington, VT Hours: Monday-Friday, 8:30am-5:00pm & 9:30am-6:00pm Position description: The Account Review Special...
  • 4 Days Ago

D
Medical Manager
  • DivIHN Integration Inc
  • Chicago, IL
  • DivIHN (pronounced “divine”) is a CMMI ML3-certified Technology and Talent solutions firm. Driven by a unique Purpose, C...
  • 5/9/2024 12:00:00 AM

R
Vice President, Global Medical Lead
  • Relay Therapeutics
  • Cambridge, MA
  • The Opportunity Relay Therapeutics is seeking a motivated and patient-centric VP who is looking to have a broad and tang...
  • 5/9/2024 12:00:00 AM

L
Field Medical Lead - Neurology - East
  • Lundbeck
  • Cambridge, MA
  • Do you want to join a team where the mission is meaningful, the challenges are complex, and you can directly see the res...
  • 5/9/2024 12:00:00 AM

M
Medical Manager
  • Meridian HealthCare
  • Youngstown, OH
  • Due to continued growth, Meridian HealthCare is searching for an energetic, detailed-oriented Medical Manager. ABOUT MER...
  • 5/8/2024 12:00:00 AM

F
Medication Management Associate
  • Fresenius Medical Care
  • Philadelphia, PA
  • PURPOSE AND SCOPE: Promotes quality patient care, ongoing customer support for Fresenius Medical Care (FMCNA) renal pati...
  • 5/7/2024 12:00:00 AM

F
Medication Management Associate
  • Fresenius Medical Care
  • Boston, MA
  • PURPOSE AND SCOPE: Promotes quality patient care, ongoing customer support for Fresenius Medical Care (FMCNA) renal pati...
  • 5/7/2024 12:00:00 AM

A
Head of Medical Writing (Hybrid MA)
  • Aerovate Therapeutics, Inc.
  • Waltham, MA
  • Aerovate (AVTE) is a clinical stage biopharmaceutical company focused on developing drugs that meaningfully improve the ...
  • 5/6/2024 12:00:00 AM

H
Regional Medical Lead
  • HeartFlow, Inc
  • New York, NY
  • HeartFlow, Inc. is a medical technology company advancing the diagnosis and management of coronary artery disease, the #...
  • 5/6/2024 12:00:00 AM

Vermont is located in the New England region of the Northeastern United States and comprises 9,614 square miles (24,900 km2), making it the 45th-largest state. It is the only state that does not have any buildings taller than 124 feet (38 m). Land comprises 9,250 square miles (24,000 km2) and water comprises 365 square miles (950 km2), making it the 43rd-largest in land area and the 47th in water area. In total area, it is larger than El Salvador and smaller than Haiti. It is the only landlocked state in New England, and it is also the easternmost and the smallest in area of all landlocked sta...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$95,942 to $122,327

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