State Licensed Clinical Manager
Job Summary
To enhance payment integrity processes, the full-time State Licensed Clinical Manager will evaluate carrier reimbursements, review medical records for billing accuracy, and lead a team of Clinical Analysts in a remote environment.
Key responsibilities
- Review medical records and claims for accuracy, compliance, and adherence to coding guidelines
- Analyze clinical and operational data to identify trends and support continuous improvement initiatives
- Lead and mentor the Clinical Analysts while collaborating with cross-functional teams to refine clinical processes
Required qualifications
- Active clinical license (RN, LPN/LVN) or relevant clinical experience
- Bachelor's degree in Nursing, Healthcare Administration, Business, or a related field; advanced degree preferred
- At least one certification such as CPC or CCS
- 5+ years of experience in claims processing, payment integrity, or healthcare administration
- Working knowledge of medical claims data and healthcare workflows
Complete Job Description
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