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)
St. John’s Regional Medical Center located in Oxnard California is a recognized as a Top 250 Hospital in the Nation and as one of America’s 100 Best Hospitals for Cardiac Care by Healthgrades. St. John’s Regional is a part of Dignity Health’s Southern California Division and is a member of CommonSpirit Health the largest not-for-profit health care system in the nation boasting an integrated network of top quality hospitals with physicians from the most prestigious medical schools and comprehensive outpatient services - all recognized for quality safety and service. Each hospital is supported by an active philanthropic Foundation to help meet the growing health care needs of our communities. Learn more at www.dignityhealth.org/StJohnsRegional.
If you are committed to social justice, health equity, and prepared to deliver care in new, innovative ways, you belong with us.
We offer the following benefits to support you and your family:
As our Nurse Manager Med/Surg Services at St. John's Regional Medical Center, you’ll oversee a department of frontline nurses and act as the conduit between these caregivers and leadership teams. You will communicate the organization’s goals to the nursing staff as we constantly seek to improve patient experiences, reach out to our community, and deliver quality care. At the same time, you will advocate for your team by bringing any issues, requests, or new ideas from them to leadership.
To thrive in this role, you must be competent and confident. Utilizing your excellent communication skills one-on-one and in front of groups, you will tackle tough conversations and, above all, be an educator at heart. Every interaction is an opportunity to share your knowledge with others and improve their understanding of a patient’s needs, the needs of the nursing staff, or the needs of the organization.
Principal Duties and Accountabilities:
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