Remote Clinical Review Manager

Job Summary

Leading a team of clinical investigators, the full-time Remote Clinical Review Manager will oversee complex fraud, waste, and abuse cases, applying clinical expertise to identify trends and collaborate with providers across multiple markets.

Key responsibilities

• Manage the review and audit processes of inappropriate billing practices and develop strategies to correct issues
• Review audit reports for accuracy and present findings to upper management
• Collaborate with providers to conduct educational training on appropriate billing patterns

Required qualifications

• Bachelor's Degree in Nursing or a related field, or equivalent experience
• 5+ years of medical coding and/or nursing experience
• Strong knowledge of medical terminology and CPT code billing
• Previous experience managing cross-functional teams or supervisory experience
• Clinical experience in a hospital, clinic setting, or emergency room preferred