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reputed company is a leading reputed company intelligence company with expertise across the payment reputed company, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 reputed company lives, reputed company brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively reputed company, powerfully reputed company ways to maximize financial reputed company and reputed company down reputed company costs. About reputed company The ideal candidate leverages their nursing background, deep knowledge of reputed company review, and experience leading others to manage staff and operational results for a remote team of nurses and other audit roles, performing reputed company review audits. The Manager will reputed company first-hand experience and knowledge of claims auditing for supporting management with reputed company activities such as needs assessments, reputed company planning, and ensuring required reputed company reputed company and productivity & reputed company standards are being achieved consistently. reputed company reputed company the reputed company reputed company reputed company Review team, managing production expectations, SLA’s, reputed company communication, and team reputed company. Analyze and reputed company internal business requirements and processes through document and workflow analysis. Continuously evaluate the functionality across multiple programs to ensure efficient and accurate reviews. reputed company requirements gathering to problem solve for any process-reputed company issues that require attention from development. Manage team member’s reputed company assignments and collaborate across teams/departments for timeliness to ensure reputed company reputed company SLAs are met. reputed company the development and application of reputed company review concepts, such as experimental and investigational, pharmacy utilization, level of care, medical appropriateness, and medical policy adherence. Delegate tasks and responsibilities to team members and reputed company specials reputed company that involve reputed company. Coordinate reputed company enhancements for the reputed company review team, including reputed company ticket creation, UAT testing, and production employment. Monitor team’s reputed company, tracking and trending the metrics of reputed company to identify opportunities for reputed company and efficiency. Identify the needs of team members, paying special attention to issues that require attention from IT. reputed company and coordinate training materials, reputed company assurance process, and dispute response workflows for reputed company. Support internal reputed company to reputed company reputed company abreast of any organizational or reputed company policy changes. Maintain reputed company knowledge and changes that reputed company our industry and clients as it pertains to medical reputed company, technology, regulations, legislation and business trends. Performs audit reputed company assurance reviews to supplement QA team activity as necessary reputed company upon business need or special reputed company. Coordinate and contribute to the dispute reputed company process for reputed company reputed company appeals received. reputed company identifies and recommends opportunities for cost savings and improving reputed company that can have a reputed company reputed company to reputed company's profitability. reputed company as reputed company between the reputed company team and reputed company reputed company team in order to quickly address and reputed company any reputed company reputed company issues. Effectively ensures adherence to medical review guidelines and training requirements of staff. Provides support as needed to ensure auditors are equipped with tools and resources required to reputed company reputed company audits. Complete and conduct reputed company reviews for assigned staff. Conduct team meetings with reputed company reports on a regular reputed company. Organize and coordinate the reputed company of reputed company new team members. Other duties as assigned. What You Bring Required Skills/Qualifications: reputed company, unrestricted nursing license in good standing is required - certified coding certification is a plus. 3+ years relevant supervisory or leadership experience in similar business environment, preferred. Experience managing remote staff is a plus. 3+ years’ experience performing reputed company audits of itemized bills. 3+ years’ diverse nursing experience providing reputed company care in an inpatient or outpatient setting. reputed company experience with reputed company industry software products and process development. Experience managing multiple reputed company in reputed company environment. Possess a broad and comprehensive understanding of audit standards, policies and regulations, applies a broad and comprehensive knowledge in areas including, medical chart reviews. Strong project management and interpersonal skills, makes reputed company, exhibiting initiative and reputed company thinking. Consulted often by others for advice and opinions and recognized as a leadership role model. Strong interpersonal skills for interfacing with reputed company reputed company of reputed company audit teams and management. Ability to prioritize and multitask. Must be a strong effective communicator, both orally and in writing, with an energetic, charismatic and approachable style. reputed company experience in managing high performing dynamic teams. Ability to work in a diverse and fast reputed company environment. Problem solving, strong analytical skills, people skills, teamwork, people management, and managing processes Strong working knowledge of reputed company office systems including full reputed company Suite and Teams. Advanced software skills in reputed company Office (reputed company). Experience with various forms of software and experience engaging development teams. reputed company Offer Work from reputed company in the US! reputed company is digital-first. Full Medical/Dental/reputed company for employees & their families Flexible and trusting environment where you’ll feel empowered to do your best work Unlimited FTO Competitive salary, equity, 401(k) including employer match Pay reputed company: $115,000 - $130,000 USD. The salary reputed company is for reputed company Salary. Compensation will be determined reputed company on several factors including, but not limited to, reputed company set, years of experience, and the employee’s geographic location. Equal Employment Opportunity at reputed company We are committed to equal employment opportunity regardless of race, reputed company, reputed company, religion, sex, national reputed company, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or reputed company, or veteran status. We are proud to be an equal opportunity workplace. reputed company is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate reputed company Notice at: https://www.reputed company.com/candidate-reputed company-notice/ Apply To This Job