Medical Claims Review Manager jobs in Utah

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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Medical Review Nurse
  • Vital Signs
  • Salt Lake, UT FULL_TIME
  • 100% Remote, Work-From-Home position anywhere in the US. (Any state RN license is accepted).

    As an RN, you will provide direction, guidance, and support to our physician Medical Claims Reviewers as well as other staff as indicated. Complete quality audits of individual case reviews.

    Support the clinical aspects of the review process and case reviews, including but not limited to:

    • Support the reviewer selection and assignment process
    • Resolve operational issues arising in connection with the clinical aspects of review cases
    • Communicate with assigned reviewers and with treating/ordering practitioners/providers
    • Support the Case Fulfillment process and provide education to analysts as appropriate
    • Advise and provide guidance to reviewers on the operational aspects of review cases in all categories (i.e., standard, and ERO cases) and provide them with information pertinent to their assigned cases and related review processes
    • Collaborate with the Chief Medical Director and Director of Provider Relations to address reviewer quality issues; support the Provider Relations assessment process


    Qualifications:

    • 2 Year Degree
    • Qualified candidates will be self-directed, assertive, and creative in problem-solving, as well as a keen eye for detail
    • Very strong computer literacy and high competency in the use of Microsoft Office are a must
    • Strong analytical skills
    • Strong oral and written communication skills
    • Ability to work under pressure and meet deadlines while managing multiple high priorities and maintain a flexible schedule


    • Schedule: 5, 8-hour shifts each week - which includes a Saturday and Sunday rotation
    • Scheduled 8 hours per day, between the hours 7am to7:00pm Mountain Time

  • Just Posted

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Medical Billing/Claims Specialist
  • Caddis Capital Management (support company of Alpine Home Medical)
  • Salt Lake, UT FULL_TIME
  • Job Location: Salt Lake/MurrayFull-time (M-F day hours)...weekends offCaddis Capital Management is the management company for Alpine Home Medical, Copper Star Home Medical Supplies and You Can Home Me...
  • 2 Days Ago

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HBS Medical Claims Trainee
  • OneTen
  • Murray, UT FULL_TIME
  • Job Essentials1. Uses proper plan documentation to determine benefits and correctly adjudicates general and specialty claims.2. Correctly logs, adjudicates and completes paper claim process within req...
  • 19 Days Ago

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Medical Claims Adjuster
  • Utah Retirement Systems
  • Salt Lake, UT FULL_TIME
  • About The Company PEHP Health & Benefits is a division of the Utah Retirement Systems that proudly serves Utah’s public employees through high quality and competitively priced medical, dental, life, a...
  • 20 Days Ago

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Medical Claims Processor
  • Iserve
  • Salt Lake, UT CONTRACTOR
  • Minimum Requirements:Experience with electronic health record (EHR) systems, especially HCHB.Background in finance, banking, or relevant healthcare financial services.Ability to read and interpret Exp...
  • 3 Days Ago

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Medical Billing/Claims/Collections
  • Robert Half
  • South Jordan, UT PER_DIEM
  • Need a collections specialist out of South Jordan Utah to follow up on denied insurance claims within the dental industry. Pay 20-26 but thinks dental experience is going to be key when it comes to be...
  • 9 Days Ago

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Orem, UT
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/28/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Fairfield, CA
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/28/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Folsom, CA
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/28/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Saratoga Springs, NY
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/28/2024 12:00:00 AM

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Medical Lead - Oncology, Medical Affairs
  • SEC Life Sciences
  • One of the world's leading pharmaceutical companies is seeking four passionate, forward-thinking individuals for key rol...
  • 3/28/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco
  • Menifee, CA
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/27/2024 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...
  • 3/25/2024 12:00:00 AM

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Head of Medical Writing
  • Morgan Prestwich - Life Science & Healthcare Executive Search
  • Company Overview Morgan Prestwich is thrilled to be representing our client on an exclusive basis. Our client is a clini...
  • 3/24/2024 12:00:00 AM

Utah is known for its natural diversity and is home to features ranging from arid deserts with sand dunes to thriving pine forests in mountain valleys. It is a rugged and geographically diverse state that is at the convergence of three distinct geological regions: the Rocky Mountains, the Great Basin, and the Colorado Plateau. Utah is one of the Four Corners states, and is bordered by Idaho in the north, Wyoming in the north and east; by Colorado in the east; at a single point by New Mexico to the southeast; by Arizona in the south; and by Nevada in the west. It covers an area of 84,899 sq mi ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$92,116 to $117,449

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