Registered Nurse Claim Review Manager

Job Summary

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