Offer summary

Qualifications:

Active USRN Mainland license is required., Minimum of 2 years in a leadership role within BPO Healthcare., Experience in ER, Med-Surg, Critical Care Units, or OR is essential., Current unrestricted licensure in the applicable state is necessary..

Key responsibilities:

Review medical claims for medical necessity and interpret customer needs.

Coordinate work activities with other supervisors and set team priorities.

Identify and resolve operational problems using defined processes and expertise.

Ensure compliance with company policies and directives while meeting short-term objectives.

Job description

Taleo ID: 2100102

Generally, reviews medical claims for medical necessity, but not limited to the following: Assess and interprets customer needs, requirements and medical records, Identifies solutions to non-standard requests and problems, Solves moderate to complex problems and do analysis with it, works with minimal guidance, translates clinical concepts into practice, provides explanations and information for difficult issues

Primary Responsibilities:

Owns output at task level
Work is generally limited to own function
Sets priorities for the team to ensure task completion
Coordinates work activities with other supervisors
Develops plans to meet short-term objectives
Identifies and resolves operational problems using defined processes, expertise and judgment
Decisions are guided by policies, procedures and business plan
Product, service or process decisions are most likely to impact individual employees and/or customers (internal or external)

Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Positions in this function require various nurse licensure and may require certification based on role and grade level. Licensure includes RN and LPN/LVN , depending on grade level, with current unrestricted licensure in applicable state. Roles are responsible for retrospective review of medical claims and application of medical and reimbursement policies. *Employees in jobs labeled with SCA must support a government Service Contract Act (SCA) agreement.

Qualifications:

>Active USRN Mainland license
>Minimum 2 years leadership role in BPO Healthcare
>Active mainland USRN License with minimum of 2 years of experience in ER/Med-Surg/Critical Care Units/OR

Required profile