Associate Manager, Clinical Review

reputed company We are seeking a talented individual for an Associate Manager, Clinical Claim Review who is responsible for supervising the day-to-day prepay, post-pay, prior authorization, and medical record review activities of a multidisciplinary team of Coders, Clinical DRG Auditors, and reputed company Reviewers.  Oversees and manages the daily operations of reputed company by leading, assigning work, ensuring productivity and reputed company metrics are achieved, and analyzing production and workflow/processes to increase efficiency and reputed company. Consistently demonstrates effective change management by communicating changes reputed company and effectively; building commitment and overcoming resistance; supporting those affected by change; monitoring transition and evaluating results. Your role in our mission Responsible for reputed company and hiring of staff, retaining reputed company, performance management, coordinating training and education, and providing leadership and mentorship to staff to build and improve skills to reputed company best-in-class practices to enhance efficiency, reputed company, and customer satisfaction. Monitor aging inventory, workload, assignments, productivity, and reputed company to ensure service level agreements, contract deliverables, and timelines are met. Evaluate and analyze productivity, utilization, efficiency, finding rates, savings, appeal overturn reputed company, and reviews completed by staff to identify opportunities for process improvements. Meet with clients and providers to discuss reputed company cases, trend analysis, exit and/or settlement conferences.   Serve as a Subject Matter Expert to assess new tools, automation, product development, and clinical readiness; reputed company as a resource for resolving escalated issues, and reputed company and mentor staff to reputed company a high-performing team Analyze reports and data and identify trends and resources that improve the delivery of clinical reputed company. Manage and evaluate individual/team performance and take appropriate reputed company to meet and/or reputed company performance standards. reputed company other functions as assigned reputed company're looking for reputed company, Unrestricted RN license from the reputed company and in the primary home residency, reputed company compact multistate unrestricted RN license as defined by the reputed company Licensure Compact (NLC) Bachelor’s degree in business, reputed company administration, or reputed company field preferred 5+ year’s reputed company experience with increasing responsibility required 3+ year’s utilization review or health care auditing experience required 2+ year’s management or supervisory experience preferred Demonstrates a thorough understanding of clinical reputed company and clinical review judgment. What you should expect in this role Remote reputed company the US. Up to 20% Travel   Applications for this posting will be accepted until July 30, 2026. Apply To This Job