Medical Policy Manager jobs in New Mexico

Medical Policy Manager manages and implements corporate policy and process for medical provider and other reimbursements. Ensures that all claims are reviewed, settled, and processed in compliance with and according to contract provisions and regulatory requirements. Being a Medical Policy Manager evaluates and develops policies and provider reimbursement guidelines to effectively manage and control medical claims cost. Requires a bachelor's degree of finance, business or healthcare administration. Additionally, Medical Policy Manager typically reports to head of a unit/department. The Medical Policy 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 Policy 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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Medical Policy RN
  • University of New Mexico - Hospitals
  • Stanley, NM FULL_TIME
  • Receive 17% weekday nights, 26% weekend nights, or 15% weekend day shift differentials
    Women's Special Care

    Casual Pool (as needed)


    Shift:
    Rotating

    Work within the nursing process to provide direct nursing care to assigned patients consistent with clinical specialty (PCU/ICU/ED etc.), Serve as a role model to promote a positive work environment and quality patient care.

    Ensure adherence to Hospitals and departmental policies and procedures. Minimum work requirement for RN Per Diem I is two shifts per schedule. One weekend shift per schedule and one summer and one winter holiday are required. Patient care assignment may include; Neonate, Pediatric, Adolescent, Adult and Geriatric age groups.

    PATIENT CARE - Deliver safe direct care to an assigned group of patients as required

    • POLICIES - Work within Hospitals, Nursing division and departmental policies
    • CARE PLAN - Work in collaboration with the healthcare team, implement and document individualized care plans incorporating age specific considerations, including discharge planning and patient/family teaching
    * upon successful completion of preceptor training assume precepting and evaluation responsibilities of new personnel

    • MEDICAL RECORDS - Ensure that patient medical records contain necessary information
    • INQUIRIES - Answer telephones and triage calls as per departmental policy
    * document and communicate clinical findings

    • PATIENT SAFETY - Follow patient safety-related policies, procedures and protocols
    • PATIENT SAFETY - Demonstrate proactive approach to patient safety by seeking opportunities to improve patient safety through questioning of current policies and processes
    • PATIENT SAFETY - Identify and report/correct environmental conditions and/or situations that may put a patient at undue risk
    • PATIENT SAFETY - Report potential or actual patient safety concerns, medical errors and/or near misses in a timely manner
    • PATIENT SAFETY - Encourage patients to actively participate in their own care by asking questions and reporting treatment or situations that they don't understand or may "not seem right"
    • PATIENT CENTERED MED - Adhere to and promote the core expectations of the Patient Centered Medical Home or Patient Centered Specialty Practice as applicable
    Program Graduate
    Bachelor's Degree
    Nationally Accredited Nursing Graduate
    Nursing

    CPR for Healthcare/BLS Prov or Prof Rescuers w/in 30 days

    • Chemicals, Bio Hazardous Materials req PPE
  • 18 Days Ago

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Medical Policy RN
  • University of New Mexico - Hospitals
  • Mcintosh, NM FULL_TIME
  • Department: COPE Clinic Casual Pool (as needed)Shift: Days Work within the nursing process to provide direct nursing care to assigned patients. Provide clinical leadership for other staff. Serve as a ...
  • 24 Days Ago

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Manager Coding Policy *Remote
  • Providence Health
  • Mexico, NM FULL_TIME
  • Description Providence Health Plan caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitme...
  • Just Posted

C
Campaigns Director
  • Center for Civic Policy
  • Albuquerque, NM FULL_TIME
  • Job Title: Campaigns Director Reports to: Chief Operating Officer, Melanie Aranda Job Purpose: [Using independent judgment and discretion], Contributes to the overall success of CCP by taking a leader...
  • 15 Days Ago

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Non-Medical Case Manager - Truman
  • UNM Medical Group
  • Albuquerque, NM FULL_TIME
  • UNM Medical Group, Inc. is hiring for a Non-Medical Case Manager to join our Truman Health Services team. This opportunity is a full-time day shift opening located in Albuquerque, New Mexico. Minimum ...
  • 5 Days Ago

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Medical Case Manager - Chronic Care
  • UNM Medical Group
  • Albuquerque, NM FULL_TIME
  • UNM Medical Group, Inc. is hiring for a Medical Case Manager to join our Truman Health Services team. This opportunity is a full-time day shift opening located in Albuquerque, New Mexico. Minimum $52,...
  • 1 Month Ago

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Senior Research Nurse - Thoracic Head & Neck Medical Oncology
  • MD Anderson
  • Houston, TX
  • The University of Texas MD Anderson Cancer Center is ranked the nation's top hospital for cancer care by U.S. News & Wor...
  • 4/18/2024 12:00:00 AM

B
Technologist-Medical Lead - MG Diagnostic Lab BMG
  • Baptist Memorial
  • Germantown, TN
  • Summary Perform all functions of the Medical Technologist and supervise the personnel and activities of various sections...
  • 4/18/2024 12:00:00 AM

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Head of Medical Writing
  • Proclinical Staffing
  • Head of Medical Writing - Permanent - Onsite Proclinical is seeking a Head of Medical Writing to join a cutting-edge bio...
  • 4/17/2024 12:00:00 AM

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Head of Medical Writing
  • Aerovate Therapeutics Inc.
  • Waltham, MA
  • Aerovate (AVTE) is a clinical stage biopharmaceutical company focused on developing drugs that meaningfully improve the ...
  • 4/16/2024 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...
  • 4/16/2024 12:00:00 AM

A
Head of Medical Writing
  • Aerovate Therapeutics, Inc.
  • Waltham, MA
  • Aerovate (AVTE) is a clinical stage biopharmaceutical company focused on developing drugs that meaningfully improve the ...
  • 4/15/2024 12:00:00 AM

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Senior Director, Global Pharmacovigilance & Risk Management Head of Medical Safety
  • Vir Biotechnology, Inc.
  • Vir Biotechnology, Inc. is an immunology company focused on combining cutting-edge technologies to treat and prevent inf...
  • 4/15/2024 12:00:00 AM

H
Regional Medical Lead - West
  • HeartFlow
  • Dallas, TX
  • HeartFlow, Inc. is a medical technology company advancing the diagnosis and management of coronary artery disease, the #...
  • 4/14/2024 12:00:00 AM

New Mexico (Spanish: Nuevo México Spanish pronunciation: [ˈnweβo ˈmexiko] (listen), Navajo: Yootó Hahoodzo pronounced [jòːtxó xɑ̀xʷòːtsò]) is a state in the Southwestern region of the United States of America; its capital and cultural center is Santa Fe, which was founded in 1610 as capital of Nuevo México (itself established as a province of New Spain in 1598), while its largest city is Albuquerque with its accompanying metropolitan area. It is one of the Mountain States and shares the Four Corners region with Utah, Colorado, and Arizona; its other neighboring states are Oklahoma to the north...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Policy Manager jobs
$120,639 to $147,276

Medical Policy Manager in Miami, FL
Each county may, under the Health & Safety Code, establish an Emergency Medical Care Committee (EMCC) with membership prescribed and appointed by the county board of supervisors.
January 02, 2020
Medical Policy Manager in Orange, CA
All Medical Device Licence holders or potential Medical Device Licence holders.
December 06, 2019
Medical Policy Manager in Fresno, CA
The Air Force has allowed more than 600 airmen to join its ranks despite having previously disqualifying medical conditions such as eczema and attention-deficit hyperactivity disorder, new statistics show.
December 29, 2019