Clinical Adjudication Manager; Weekday Evening Shift Part C)

Job Title

Manages project activities and participates in the development and monitoring of all related tasks. Manages medical and non-medical appeals decisions.

Essential Responsibilities:

• Plans and manages project activities to meet contract deliverables.
• Plans, manages, and develops a standardized approach for dissemination and communication of project information.
• Plans, manages, and develops presentations or instructional materials related to area of responsibility.
• Plans, prepares, and facilitates regular team meetings.
• Manages, trains, and evaluates project work activities and personnel.
• Manages the administrative processing of appeals/disputes and the coordination of workflow among internal staff and subcontractors.
• Manages, establishes, and maintains professional and effective working relationships with external business partners and internal staff.

Minimum Qualifications

Education:

• Associate's degree or 60 or more credit hours towards a Bachelor's degree from an accredited college or university in healthcare or related discipline
• Additional clinical or medical administration experience may be substituted for Associate's degree on a year per year basis. (Experience requirements may be satisfied by full-time experience or the prorated part-time equivalent.)

Experience:

• Five (5) years conducting or overseeing Medicare appeals, medical review, or utilization management of Medicare claims.
• Three (3) years management or supervisory
• Healthcare Professional with one (1) year demonstrated experience writing, making, or overseeing Medicare related medical necessity decisions
• Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience
• Conducting or overseeing Medicare Part C related appeals activities, preferred

Benefits

• Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
• Section 125 plan
• 401K
• Competitive salary
• License/credentials reimbursement
• Tuition Reimbursement

EOE Vet/Disability

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.