Medical Claims Review Manager jobs in Indiana

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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Case Manager - Utilization Review
  • Monroe Hospital
  • Bloomington, IN FULL_TIME
  • Overview:
    At Monroe Hospital, our dedicated team of professionals is committed to our core values of quality, compassion, and community. As a member of Prime Healthcare, a Top-15 hospital system in the United States, Monroe Hospital is actively seeking new members to join its award-winning team!

    Monroe Hospital is a 32-bed community hospital located in beautiful Bloomington, Indiana. Monroe Hospital is committed to providing superior healthcare, ever mindful of each patient's individuality and unique needs. Monroe Hospital has been recognized by Healthgrades as a Patient Safety Excellence Award recipient, a distinction that places Monroe Hospital among the top 10% of all short-term acute care hospitals. For more information, please visit www.monroehospital.com.

    We are an Equal Opportunity Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation, or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf
    Responsibilities:
    Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management. Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.
    Qualifications:
    Education and Work Experience
    • Starting April 1 2015. Minimum 5 years work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license.
    • Grandfathered prior to April 1, 2015. Minimum 5 years post graduate of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.
    • Five years acute care nursing experience preferred. At least one year experience in case management, discharge planning or nursing management, preferred.
    • Current BCLS (AHA) certificate upon hire and maintain current.
    • Knowledge of Milliman Criteria and InterQual Criteria preferred.
    • Experience and knowledge in basic to intermediate computer skills.
    • Behavioral Violence Prevention Training within 3 months of hires and maintain current.
    #LI-AS2
  • 18 Days Ago

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Healthcare Claims Processor
  • Rehab Medical
  • Indianapolis, IN FULL_TIME
  • Jumpstart your career at Rehab Medical, one of the nation’s leading providers of custom advanced medical equipment and a recent Inc 5000 fastest growing U.S. company award winner! Based in Indianapoli...
  • Just Posted

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Medical Claims Specialist - Hybrid
  • AC3, Inc.
  • South Bend, IN FULL_TIME
  • WHO WE ARE: AC3 was founded by practicing oncologists along with data and practice analytics experts to support the business side of medicine. Our mission is to modernize and digitize the delivery of ...
  • 1 Month Ago

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Medical Claims Representative
  • Robert Half
  • Fort Wayne, IN PER_DIEM
  • Needing a medical claims follow-up individual. Responsibilities include: * Must have a medical background* Claims follow-up experience* Follow-up on insurance* Patient claims paid* Customer service* M...
  • 28 Days Ago

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District Manager
  • District Manager
  • Elkhart, IN FULL_TIME
  • Description Using your past leadership experience, you will: Grow a portfolio of successful businesses: Develop district-level strategies to achieve each restaurant’s financial, operational and custom...
  • 11 Days Ago

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Administration/Data Entry - Entry Level
  • Balance Claims
  • Indianapolis, IN FULL_TIME
  • Job SummaryBalance, LLC, America’s Services Company for Contractors, is always looking for motivated Administrative Professionals in Indianapolis, IN. Our Shared Service Department administratively in...
  • 1 Day Ago

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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 ...
  • 4/26/2024 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...
  • 4/26/2024 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 #...
  • 4/26/2024 12:00:00 AM

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US Pneumococcal Adult Medical Lead, MD
  • Pfizer
  • New York, NY
  • ROLE SUMMARY Provide pneumococcal franchise leadership on behalf of Asset Medical Affairs team. * Collaborates with Bran...
  • 4/26/2024 12:00:00 AM

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Medical Director, Medical Management
  • Imperial Health Plan Of California Inc.
  • Pasadena, CA
  • People are the most important asset of Imperialfor this reason the difference and plurality of people, equality of oppor...
  • 4/26/2024 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 ...
  • 4/25/2024 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...
  • 4/25/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco
  • Baldwin, NY
  • Create a healthier, brighter future for pets, pet parents and people!If you want to make a real difference, create an ex...
  • 4/23/2024 12:00:00 AM

Indiana /ˌɪndiˈænə/ (listen) is a U.S. state located in the Midwestern and Great Lakes regions of North America. Indiana is the 38th largest by area and the 17th most populous of the 50 United States. Its capital and largest city is Indianapolis. Indiana was admitted to the United States as the 19th U.S. state on December 11, 1816. Indiana borders Lake Michigan to the northwest, Michigan to the north, Ohio to the east, Kentucky to the south and southeast, and Illinois to the west. Before becoming a territory, various indigenous peoples and Native Americans inhabited Indiana for thousands of ye...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$94,645 to $120,673

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