Medical Claims Review Manager jobs in Virginia
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)
Recently Added Medical Claims Review Manager jobs
Claims Clinical Specialist - Medical Review Team
- gnw
-
Richmond, VA
FULL_TIME
- At Genworth, we empower families to navigate the aging journey with confidence. We are compassionate, experienced allies for those navigating care with guidance, products, and services that meet families where they are. Further, we are the spouses, children, siblings, friends, and neighbors of those that need care—and we bring those experiences with us to work in serving our millions of policyholders each day. We apply that same compassion and empathy as we work with each other and our local communities, Genworth values all perspectives, characteristics, and experiences so that employees can bring their full, authentic selves to work to help each other and our company succeed. We celebrate our diversity and understand that being intentional about inclusion is the only way to create a sense of belonging for all associates. We also invest in the vitality of our local communities through grants from the Genworth Foundation, event sponsorships, and employee volunteerism. Our four values guide our strategy, our decisions, and our interactions: Make it human. We care about the people that make up our customers, colleagues, and communities. Make it about others. We do what’s best for our customers and collaborate to drive progress. Make it happen. We work with intention toward a common purpose and forge ways forward together. Make it better. We create fulfilling purpose-driven careers by learning from the world and each other. POSITION TITLE Claims Clinical Specialist – Medical Review Team POSITION LOCATION This position is available to Virginia residents as Richmond or Lynchburg, VA Hybrid in-office applicants or remote applicants residing in states/locations under Eastern or Central Standard Time: Alabama, Arkansas, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Virginia, Washington DC, Vermont, West Virginia or Wisconsin. YOUR ROLE As an Operations team member, you will play a crucial role in delivering world class customer service and capabilities to our policyholders – now and in the future. The Claims Clinical Specialist role is an excellent opportunity for a Registered Nurse seeking a career change. Bring your nursing knowledge and experience, and Genworth will provide the training necessary to succeed as a Medical Review Nurse. You will be responsible for improving our in-house certification functions by providing updates to the plan of care, in-house certifications, completing assessments, and monitoring low-risk claimants. This position will promote the provision of evidence-based, short-term case management services to long-term care insurance policyholders. What you will be doing You will be responsible for communicating with medical personnel at Long Term Care Facilities by conducting telephonic assessments for claimants to develop the plan of care and provide tax qualified certifications as required by the policy. You will be responsible for obtaining information about the medical status and care needs of the insured to best understand the disease progression, ADL/IADL loss, and cognitive status. You will be responsible for making decisions about the care need expectations and benefit eligibility of the insured as it aligns with specific policy requirements and the HIPAA regulations related to Tax Qualification Certification. You will be responsible for working within a structured environment with established Standard Operating Procedures to ensure consistency of claims practices. You will be responsible for communication, teamwork and collaboration, and partnering with other teams or departments to achieve common goals and support continuous improvement initiatives. You will be responsible for identifying, requesting, and analyzing pertinent medical records required to best understand the disease progression, ADL/IADL loss and potential for recovery. You will identify process improvement opportunities, provide feedback on processes and case management model as well as be a critical team member in enhancing the team’s performance and results. What you bring Active Registered Nurse (RN) licensure At least two years-experience working in a role that required an understanding of single and cumulative medical conditions (particularly those common in the aging process), including their effect on physical/cognitive function, as well as their prognosis and rehabilitative potential. Able to understand and interpret MDS, Plan of Care, Physician Records and Occupational/Physical Therapist records and understand disease progression and recovery expectations. Extraordinary internal and external customer service skills including patience, tactfulness, ability to remain calm and composed under pressure, effective listening skills, and professionalism. Able to manage and prioritize a work queue and multiple job responsibilities. You will be expected to have consistent, reliable, and predictable attendance to support the needs of the business. Ability to understand and Interpret Insurance Contracts and Long-Term Care Benefits. Good working knowledge of systems applications (e.g., WORD, EXCEL, PowerPoint, etc.). Nice to Have Bachelor’s Degree in Nursing, similar sciences, or higher postgraduate education At least 2 years of medical experience with older adults and their families (hospital, nursing home, or community placements). Experience in a Long -Term Care and/or Hospice setting Strong knowledge of senior/geriatric/home health care, continuum of care, long-term care insurance and/or the Medicare program. Geriatric medical knowledge. Employee Benefits & Well-Being Genworth employees make a difference in people’s lives every day. We’re committed to making a difference in our employees’ lives. Competitive Compensation & Total Rewards Incentives Comprehensive Healthcare Coverage Multiple 401(k) Savings Plan Options Auto Enrollment in Employer-Directed Retirement Account Feature (100% employer-funded!) Generous Paid Time Off – Including 12 Paid Holidays, Volunteer Time Off and Paid Family Leave Disability, Life, and Long Term Care Insurance Tuition Reimbursement, Student Loan Repayment and Training & Certification Support Wellness support including gym membership reimbursement and Employee Assistance Program resources (work/life support, financial & legal management) Caregiver and Mental Health Support Services ADDITIONAL The base salary pay range for this role starts at a minimum rate of $ 65,600 up to the maximum of $121,300. In addition to your base salary, you will also be eligible to participate in an incentive plan. The incentive plan is based on performance and the target earning opportunity is 7% of your base compensation. The final determination on base pay for this position will be based on multiple factors at the time of this job posting including but not limited to geographic location, experience, and qualifications to ensure pay equity within the organization. Genworth Financial, Inc. (NYSE: GNW) is a Fortune 500 provider of products, services and solutions that help families address the financial challenges of aging. Headquartered in Richmond, Virginia, we apply our nearly 150 years of experience each day to helping people navigate caregiving options and fund their long term care needs. Genworth is also the parent company of publicly traded Enact Holdings, Inc. (Nasdaq: ACT), a leading U.S. mortgage insurance provider. For more information on Genworth, please visit https://www.genworth.com/. From time to time Enact separately releases financial and other information about its operations. This information can be found at https://ir.enactmi.com/. Genworth Mexico Genworth US We know we can’t deliver on our mission unless we deliver for our employees. That’s why we’re committed to creating a work environment that fosters inclusion, excellence, improvement and connection. We know each employee contributes in their own unique way and we’re dedicated to supporting every one of them to help them reach their full potential. We are proud to be an equal opportunity employer and all hiring decisions are based on merit, qualifications, and business need. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.
- 7 Days Ago
Medical Review Manager (Full-time, Remote)
- Integrity Management Services, Inc.
-
Alexandria, VA
FULL_TIME
- About UsIntegrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients in compliance and program integrity...
- 1 Day Ago
Review Project Manager
- Innovative Discovery LLC
-
Arlington, VA
FULL_TIME
- Innovative Discovery is seeking an experienced Review Project Manager in its DC metro area offices to provide management and execution of managed review projects for a broad spectrum of ID’s clients, ...
- Just Posted
Medical Claims Specialist
- Robert Half
-
Allen, VA
FULL_TIME
- We are offering a contract- permanent employment opportunity in the healthcare industry for a Medical Billing Specialist in Glen Allen, Virginia. This role requires a detail-oriented professional who ...
- 6 Days Ago
Medical Billing/Claims/Collections
- Robert Half
-
Hampton, VA
FULL_TIME
- We are offering a role in the healthcare industry located in Hampton, Virginia. This role revolves around Medical Billing, Claims, and Collections and is a short-term contract employment opportunity. ...
- 15 Days Ago
Commercial General Liability Claims Adjuster
- TheBest Claims Solutions
-
Richmond, VA
FULL_TIME
- Our client, an A rated insurance carrier, is looking to add a Commercial General Liability Claims Adjuster to their staff. This is a desk position involving litigated and non-litigated general liabili...
- 13 Days Ago
Medical Claims Review Manager jobs at Popular Companies
Head of Medical Writing
- Barrington James
-
San Francisco, CA
- Head of Medical Writing - Rare disease Biotech We are currently partnered with a growing, west coast based biotech focus...
- 6/2/2024 12:00:00 AM
Hospital Medical Leader
- Petco Health and Wellness Company, Inc.
-
Plainview, NY
- Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
- 6/2/2024 12:00:00 AM
Hospital Medical Leader
- Petco
-
Santa Rosa, CA
- Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
- 5/31/2024 12:00:00 AM
Hospital Medical Leader
- Petco Health and Wellness Company, Inc.
-
Saratoga Springs, UT
- Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
- 5/30/2024 12:00:00 AM
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...
- 5/30/2024 12:00:00 AM
Head of Medical Writing
- Barrington James
-
- Clinical-stage biopharmaceutical company in San Francisco, is seeking a Head of Medical Writing. This leadership role in...
- 5/29/2024 12:00:00 AM
Head of Medical Strategy
- ExecuSearch
-
Atlanta, GA
- The Head of Medical Strategy provides medical expertise to the rheumatology commercial and medical teams and provides cl...
- 5/29/2024 12:00:00 AM
Head of Medical Strategy Rheumatology
- UCB
-
Atlanta, GA
- Make your mark for patients The Head of Medical Strategy provides medical expertise to the rheumatology commercial and m...
- 5/29/2024 12:00:00 AM
About Virginia
Virginia (/vərˈdʒɪniə/ (listen)), officially the Commonwealth of Virginia, is a state in the Southeastern and Mid-Atlantic regions of the United States located between the Atlantic Coast and the Appalachian Mountains. Virginia is nicknamed the "Old Dominion" due to its status as the first English colonial possession established in mainland North America and "Mother of Presidents" because eight U.S. presidents were born there, more than any other state. The geography and climate of the Commonwealth are shaped by the Blue Ridge Mountains and the Chesapeake Bay, which provide habitat for much of ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$98,318 to $125,357
Most Popular Cities in Virginia for Medical Claims Review Manager Jobs
What does a Medical Claims Review Manager do?
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 examiners view of a particular bills status in a claim records related bill screen, or a bill review analysts 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