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)
External Quality Review (EQR) Contract Manager
Remote Employment
Who We Are:
Constellation Quality Health is a non-profit health care quality consultancy and QIO-like Entity certified by Centers for Medicare and Medicaid Services (CMS) founded by physicians in 1983. Headquartered in North Carolinas Research Triangle, we offer an array of quality improvement, clinical review, audit, technical, and consulting services and solutions to improve care delivery, system performance, and patient outcomes.
What Youll Do:
We are seeking an External Quality Review (EQR) Contract Manager to be responsible for the effective and efficient operation of assigned contracts and services. This position plays a key role assisting with identification and capitalizing on business opportunities and providing maximum value to the customer!
We expect you to:
This is a remote work opportunity for the right candidate!
Who You Are:
The successful incumbent candidate will be a leader who maintains professional working relationships with health plans, state Medicaid agency contract staff and program leaders, and all internal and external customers. This management position will proactively identify and assist with the development of plans and activities to expand EQR contract opportunities; and provide maximum value to the customers. Responsibilities include monitoring contract performance, identifying future business opportunities, developing process improvements and enhancements, and establishing operational workflows and procedures for the EQR service line.
Our requirements for this role:
Why Constellation Quality Health?
We offer a competitive salary and benefits package and a flexible, supportive hybrid work environment.
Equal opportunity employer of protected veterans
Equal opportunity employer of individuals with disabilities
We do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, gender identity, national origin, medical condition, disability, veteran status, or any other basis protected by law.
Applicants and employees are protected from discrimination based on inquiring about, disclosing, or discussing compensation or the compensation of other applicants or employees.