Medical Claims Review Manager jobs in Georgia

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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RN Case Manager - Utilization Review (FT Days)
  • Utilization Review (FT Days) - Grady Health System Careers
  • United States, GA FULL_TIME
  • SUMMARY 
     

    The Nurse Case Manager collaborates with other members of the case management and health care teams, utilizes professional nursing skills to:  assist the patient in achieving optimal health; assure appropriate use of health care resources; facilitate/coordinate timely care along the continuum; decrease unnecessary variances in care through proactive case management; develop a safe and timely discharge plan to meet the patient’s needs.

    QUALIFICATIONS 
     

    • Bachelor's Degree required, preferably in Nursing.
    • Current Georgia Registered (RN) license
    • Current Basic Life Support Healthcare Provider (American Heart Association) certification required. 
    • Minimum of  three years of direct nursing experience and demonstrated clinical competence required. 
    • Experience in Case Management preferred. 
    • Knowledge of age specific needs of population served.     

    Equal Opportunity Employer-Minorities/Females/Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity.

                                                                                                                                                                                                    

  • 1 Month Ago

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Utilization Review - NRN
  • Houston Medical Center
  • Warner Robins, GA FULL_TIME
  • Care Management Full Time · 8:00a - 4:00p · Call typically not required H14 The Non RN (NRN) Utilization Reviewer performs concurrent, extended stay and retrospective reviews of admissions using estab...
  • 6 Days Ago

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Quality Review Manager
  • Examworks Group, Inc.
  • Lawrenceville, GA OTHER
  • Overview We are seeking passionate and skilled RN’s to serve as a Quality Review Manager, reviewing cases and ensuring all necessary information has been provided and is accurate before sending back t...
  • 21 Days Ago

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Quality Review Manager
  • ExamWorks, Inc.
  • Lawrenceville, GA FULL_TIME
  • Quality Review Manager Requisition ID 2024-10283 # of Openings 1 Category Operations Location US-GA-Lawrenceville Overview We are seeking passionate and skilled RN's to serve as a Quality Review Manag...
  • 22 Days Ago

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Manager - Claims
  • Inspire Brands
  • Atlanta, GA FULL_TIME
  • The Manager - Claims is responsible for implementing efficient claims management procedures and establishing protocols for successful claims resolution for all commercial insurance policies through de...
  • 17 Days Ago

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Claims Manager
  • Coalition, Inc.
  • Atlanta, GA FULL_TIME
  • About us Coalition is the world's first Active Insurance provider designed to help prevent digital risk before it strikes. Founded in 2017, Coalition combines broad insurance coverage with a digital r...
  • 8 Days Ago

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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...
  • 4/22/2024 12:00:00 AM

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Vice President, Head of Medical Affairs / Oncology
  • Nuvalent Inc.
  • Cambridge, MA
  • The Company: With deep expertise in chemistry, Nuvalent is working to create selective medicines designed with the goal ...
  • 4/22/2024 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 ...
  • 4/21/2024 12:00:00 AM

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Veterinarian - Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Montclair, NJ
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 4/21/2024 12:00:00 AM

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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 #...
  • 4/21/2024 12:00:00 AM

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Regional Medical Lead
  • HeartFlow
  • New York, NY
  • HeartFlow, Inc. is a medical technology company advancing the diagnosis and management of coronary artery disease, the #...
  • 4/21/2024 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 ...
  • 4/20/2024 12:00:00 AM

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Assistant-Certified Medical Lead
  • Baptist Memorial
  • Memphis, TN
  • Summary Provides personal care assistance to patients under the direction of licensed personnel and /or Administrator. P...
  • 4/20/2024 12:00:00 AM

Georgia is a state in the Southeastern United States.Beginning from the Atlantic Ocean, the state's eastern border with South Carolina runs up the Savannah River, northwest to its origin at the confluence of the Tugaloo and Seneca Rivers. It then continues up the Tugaloo (originally Tugalo) and into the Chattooga River, its most significant tributary. These bounds were decided in the 1797 Treaty of Beaufort, and tested in the U.S. Supreme Court in the two Georgia v. South Carolina cases in 1923 and 1989. The border then takes a sharp turn around the tip of Rabun County, at latitude 35°N, thou...
Source: Wikipedia (as of 04/17/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$94,352 to $120,300

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