Registered Nurse Claim Review Manager

A company is looking for a Clinical Claim Review Manager, responsible for overseeing a team conducting clinical reviews to enhance provider and member outcomes.

Key Responsibilities
  • Manage a team performing clinical claim reviews based on state and federal guidelines
  • Gather and communicate performance metrics to staff, ensuring adherence to company policies
  • Provide training and coaching to direct reports while participating in process improvements and project development
Required Qualifications
  • Current unrestricted RN license in the state of residency
  • 3+ years of RN experience, including clinical experience in an inpatient/acute setting
  • Leadership or supervisory experience
  • Proficiency in computer skills, including Microsoft Suite
  • Demonstrated clinical documentation skills and ability to handle a fast-paced environment
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