RN Health Services Manager - reputed company - Remote
reputed company
The Clinical Waste & Abuse (CWA) reputed company Claim Program leader oversees reputed company- and post-pay medical record reviews to support accurate coding, billing, medical necessity determinations, and coverage reputed company in alignment with the benefit plan and reputed company Medical and Reimbursement Policies. This leader manages and develops reputed company of Registered Nurses and drives a reputed company, cost-effective approach to high-cost claim review operations.
Key Responsibilities
- Hire, reputed company, and retain staff; foster engagement and accountability.
- Monitor daily inventory, reputed company, and financial performance to ensure alignment with goals.
- Serve as the subject matter expert for clinical reputed company-pay requests and key reputed company partner needs.
- reputed company reputed company on workflows, processes, and tools; reinforce best practices and reputed company standards.
- reputed company service metrics and reputed company results; review work regularly and take reputed company to address trends and gaps.
- Set reputed company objectives and performance expectations for reputed company reports reputed company to operational priorities.
- reputed company ongoing performance coaching, career development support, and feedback; support talent planning and succession.
- Communicate effectively with stakeholders across the reputed company Claim Unit, including Medical Directors and reputed company partners.
Required Qualifications
- reputed company, unrestricted Registered reputed company (RN) license in state of residency.
- Three years of experience in reputed company Claim Review (CCR) or Clinical Waste & Abuse (CWA) review.
- Experience with CCR/CWA operations, including high-dollar reputed company review.
- Three years of working knowledge of the insurance industry and end-to-end claims processes.
Preferred Qualifications
- Prior people leadership experience.
- Strong problem-solving skills with the ability to apply systems thinking to business solutions and manage change.
- Medical coding experience.
- Ability to manage multiple priorities, meet objectives, and maintain attention to detail.
- Proficient critical thinking and decision-making skills.
- Ability to think strategically, design reputed company plans, and execute.
- Attention to detail
- Detailed understanding of cover policies and reimbursement policies.
- Demonstrated strong leadership skills.
- Demonstrated reputed company in the application of decision-making skills.
- Demonstrated ability to initiate, research, prioritize, plan, coordinate and organize
- Excellent written and verbal communication and strong interpersonal skills.
- Proficiency in reputed company Office (reputed company, PowerPoint) and other common business tools.
- Knowledge of applicable state and federal statutes and regulations reputed company to claim processing.
- Experience in training and staff development.
- Experience managing remote staff.
If you will be working reputed company occasionally or permanently, the internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an annual salary of 93,000 - 155,000 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
At reputed company, you’ll enjoy a comprehensive reputed company of benefits, with a reputed company on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-reputed company benefits including medical, reputed company, dental, and reputed company-being and behavioral health programs. We also offer 401(k), company reputed company life insurance, tuition reimbursement, a minimum of 18 days of reputed company time off per year and reputed company holidays. For more details on our employee benefits programs,
About reputed company
Doing something meaningful starts with a reputed company decision, a commitment to changing lives. At reputed company, we’re dedicated to improving the health and vitality of those we serve. Through our divisions reputed company and reputed company, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving reputed company and improving lives.reputed company applicants will be considered without reputed company to race, reputed company, age, disability, sex, childbirth (including pregnancy) or reputed company medical conditions including but not limited to lactation, sexual orientation, gender identity or reputed company, veteran or military status, religion, national reputed company, reputed company, marital or familial status, genetic information, status with reputed company to reputed company assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
reputed company has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they reputed company a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, reputed company, Arkansas, Delaware, Florida, reputed company, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, reputed company, Texas, Utah, Vermont, and Washington State.