Manager, Complex Clinical Review

🕒 il y a 28 jours

🇺🇸 États-Unis – Télétravail

💵 $115 000 - $130 000 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

👔 Manager

🦅 Parrain de Visa H1B

Cette entreprise a parrainé des visas H1B par le passé.

👻 Score fantôme 0%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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Machinify

Site WebLinkedInTous les Emplois

1001 - 5000 employés

🏥 Santé

💼 Conseil

📦 Logistique

💰 €10 000 000 Series A - Machinify en 2018-10

Healthcare • Consulting • Logistics

Machinify est une entreprise de plateforme et de services d'IA axée sur la santé qui transforme les paiements et l'intégrité des paiements dans le domaine de la santé. Son système d'exploitation d'IA unifie les demandes de remboursement, les dossiers médicaux, les contrats et les politiques, et utilise des modèles fondamentaux et des agents spécifiques à certaines tâches pour automatiser et améliorer le codage, la précision des paiements, les recouvrements et l'évitement de coûts. Machinify sert les régimes d’assurance maladie (y compris 18 des 20 principaux), prend en charge des déploiements internalisés, hybrides ou entièrement gérés, et met l'accent sur des résultats mesurables — avec plus de 85 clients, couvrant 270 millions de vies assurées, et évitant et récupérant plus de 6 milliards de dollars de coûts annuels.

Description

• Oversee the Complex Clinical Bill Review team, managing production expectations, SLAs, client communication, and team performance • Analyze and track internal business requirements and processes through document and workflow analysis • Evaluate functionality across multiple programs to ensure efficient and accurate reviews • Perform requirements gathering to resolve process-related issues requiring development support • Manage team assignments and collaborate across teams and departments to meet internal and external SLAs • Oversee development and application of clinical review concepts, including experimental and investigational, pharmacy utilization, level of care, medical appropriateness, and medical policy adherence • Delegate tasks and oversee special projects • Coordinate system enhancements, including JIRA ticket creation, UAT testing, and production deployment • Monitor team performance metrics to identify growth and efficiency opportunities • Identify team member needs, including issues requiring IT attention • Develop and coordinate training materials, quality assurance processes, and dispute response workflows • Support internal operations regarding organizational or client policy changes • Maintain current knowledge of medical practice, technology, regulations, legislation, and business trends • Perform audit quality assurance reviews as needed • Coordinate and contribute to clinical appeals dispute resolution • Recommend cost-saving and outcome-improvement opportunities • Liaise between Operations and Client Success to resolve client issues • Ensure adherence to medical review guidelines and staff training requirements • Equip auditors with required tools and resources • Complete performance reviews for assigned staff • Conduct regular team meetings with direct reports • Organize onboarding for new team members • Perform other duties as assigned

🎯 Exigences

• Current, unrestricted nursing license in good standing is required • Certified coding certification is a plus • 3+ years relevant supervisory or leadership experience in similar business environment, preferred • Experience managing remote staff is a plus • 3+ years’ experience performing clinical audits of itemized bills • 3+ years’ diverse nursing experience providing direct care in an inpatient or outpatient setting • Proven experience with healthcare industry software products and process development • Experience managing multiple projects in a team environment • Broad and comprehensive understanding of audit standards, policies and regulations, including medical chart reviews • Strong project management and interpersonal skills • Ability to prioritize and multitask • Strong effective communication skills, both orally and in writing • Proven experience managing high performing dynamic teams • Ability to work in a diverse and fast paced environment • Problem solving, strong analytical skills, people skills, teamwork, people management, and managing processes • Strong working knowledge of Windows office systems including full Microsoft Suite and Teams • Advanced software skills in Microsoft Office (Excel) • Experience with various forms of software and engaging development teams

🏖️ Avantages

• Work from anywhere in the US • Full Medical/Dental/Vision for employees & their families • Flexible and trusting environment • Unlimited FTO • Competitive salary • Equity • 401(k) including employer match