Medical Claims Review Manager jobs in Ventura, 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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Nurse Manager Medical/Surgical
  • St Johns Regional Medical Center
  • OXNARD, CA FULL_TIME
  • Overview

    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:

    • Annual Incentive (Bonus) Program.
    • Matching Retirement Program.
    • Pension fully funded by the Hospital.
    • Tuition Assistance for career growth and development.
    • Health/Dental/Vision Insurance.
    • Free Membership to our Care@Work program supporting child care, pet care, and adult dependent needs.
    • Employee Assistance Program (EAP) for you and your family.
    • Flexible spending accounts.
    • Voluntary Protection: Group Accident, Critical Illness, and Identity Theft.
    • Wellness Program.
    • Paid Time Off (PTO).

    Responsibilities
    Position Summary:
     

    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:

     

    • Oversee a department of nurses, ensuring everyone has what they need to deliver the best care possible to our patients.
    • Engage with the floor. Talk to the nurses, the patients, and families. Keep your finger on the pulse of your department so you can keep things running smoothly.
    • Attend meetings with leadership to learn about new initiatives, budgetary status, areas for improvement, etc., and bring this information back to your team of nurses.
    • Monitor attendance among nursing staff, watching for any patterns of missed shifts which may need addressing.
    • Monitor productivity and efficiency of your department, including budgets. We want to achieve the best throughput while never compromising on care.
    • Mentor people on your team. Share your knowledge and confidence with assistant nurse managers, charge nurses, and others. Build them into potential nurse managers like yourself.

    Qualifications
    Education and Experience: 
    • Bachelor's Degree in Nursing or equivalent education and experience. Magnet Hospital: BSN required.
    • Minimum of three (3) years of nursing experience and one (1) year of leadership experience.
    Licensure: 
    • Registered Nursing License (RN) in state of practice, Basic Life Support (BLS), other credentials or credential modules may be required.

     

     

    #LI-DH

  • 3 Days Ago

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Claims Supervisor
  • Pennymac
  • Moorpark, CA FULL_TIME
  • PENNYMAC Pennymac (NYSE: PFSI) is a specialty financial services firm with a comprehensive mortgage platform and integrated business focused on the production and servicing of U.S. mortgage loans and ...
  • 19 Days Ago

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Claims Analyst
  • ALKEME
  • Thousand Oaks, CA FULL_TIME
  • DescriptionPosition Summary:Looking for a detail-oriented, proactive individual with a passion for assisting clients and ensuring their peace of mind during challenging times. In this role, you will p...
  • 24 Days Ago

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Claims Processor
  • Pennymac
  • Moorpark, CA FULL_TIME
  • PENNYMAC Pennymac (NYSE: PFSI) is a specialty financial services firm with a comprehensive mortgage platform and integrated business focused on the production and servicing of U.S. mortgage loans and ...
  • Just Posted

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Medical Writing Manager
  • Amgen
  • Thousand Oaks, CA FULL_TIME
  • HOW MIGHT YOU DEFY IMAGINATION?You’ve worked hard to become the professional you are today and are now ready to take the next step in your career. How will you put your skills, experience and passion ...
  • 7 Days Ago

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Medical Spa Assistant Manager
  • Beverly Hills Rejuvenation Center
  • Westlake, CA FULL_TIME
  • Spa Assistant Manager Job Description: The Assistant Manager is a part of the decision-making team that helps the business continuously grow and improve. They have knowledge of the business’s operatio...
  • 7 Days Ago

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

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Medical Office Assistant I/II/III (Regular and Per Diem Pool) - Customer Service
  • Ventura County
  • Ventura, CA
  • Medical Office Assistant I/II/III (Regular and Per Diem Pool) - Customer Service Print (https://www.governmentjobs.com/c...
  • 3/29/2024 12:00:00 AM

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Alcohol and Drug Treatment Specialist I/II/III
  • Ventura County
  • Ventura, CA
  • Alcohol and Drug Treatment Specialist I/II/III Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/42018...
  • 3/29/2024 12:00:00 AM

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Engineering Manager I/II/III
  • Ventura County
  • Ventura, CA
  • Engineering Manager I/II/III Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/3985486) Apply ? Engine...
  • 3/29/2024 12:00:00 AM

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Internal Medicine Physician
  • CommonSpirit Health
  • Ventura, CA
  • **Dignity Health Medical Group - Ventura** is seeking a Primary Care Provider dedicated to delivering high quality, comp...
  • 3/29/2024 12:00:00 AM

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Physician Assistant (PA-C) or Nurse Practitioner (NP), per diem
  • Ageless Mens Health
  • Oxnard, CA
  • Foster real relationships. Advance the cause of mens health. Improve lives. With over 70 clinics nationwide and a growin...
  • 3/28/2024 12:00:00 AM

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Hospice LVN Per Diem (1 year experience)
  • Cardinal Care Hospice Inc
  • Ventura, CA
  • Job Description Job Description Responsibilities of Per Diem LVN include but not limited to: Must have 1 year Hospice Ex...
  • 3/25/2024 12:00:00 AM

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Psychiatric Nurse Practitioner (PMHNP-BC) - Oxnard, CA (Remote)
  • Careerbuilder
  • Oxnard, CA
  • Psychiatric Nurse Practitioner ( PMHNP-BC ) $135k - $160k/year Position Requirement: Full - Time FLSA Status: Exempt Loc...
  • 3/25/2024 12:00:00 AM

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Lvl III Staff RN - Clinic - Per Diem - Oncology - Infusion
  • Kaiser Permanente
  • Ventura, CA
  • Description: Job Summary: As the leader of the health care team, provides professional nursing care, utilizing the nursi...
  • 3/25/2024 12:00:00 AM

Ventura is located northwest of Los Angeles on the California coast. The western portion of the city stretches north along the Ventura River and is characterized by a narrow valley with steeply sloped areas along both sides. The steep slopes of the Ventura foothills abut the northern portion of the community. Much of the eastern portion is on a relatively flat alluvial coastal plain lying along the western edge of the Oxnard Plain. The Santa Clara River forms the city's southerly boundary with the city limits reaching up to the beginning of the Santa Clara River Valley at the historic communit...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$104,362 to $133,063
Ventura, California area prices
were up 2.5% 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