Medical Review Supervisor

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🏈 Alabama, South Carolina, +2 more states – Remote

🏈 Alabama – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote ⚔️ Virginia – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Palmetto GBA

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1965

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Palmetto GBA is one of the nation's largest providers of high-volume Medicare claims and transaction processing, contact center operations, and technical services for federal healthcare programs and commercial customers. The company serves as a Medicare Administrative Contractor (MAC) and supports enrollment, claims adjudication, provider and beneficiary services, specialized programs (e. g. , DMEPOS, Home Health & Hospice, Railroad Medicare), pricing and coding analysis, and third-party administrator functions. Headquartered in Columbia, South Carolina, Palmetto GBA operates across multiple Medicare jurisdictions and is part of the Celerian Group.

📋 Description

• Manage day-to-day activities for assigned staff • Identify training needs and verify accuracy and timeliness of workflow functions • Supervise staff, including approval of time, leave, and performance reviews • Select, train, and motivate staff to provide excellent customer service • Perform quality control functions for work performed • Develop work plans to improve quality performance • Prepare, review, and maintain weekly and monthly reports • Develop, maintain, and update procedures and documentation for conducting audits • Develop and communicate department standards and staff expectations • Coordinate special projects and system testing enhancements

🎯 Requirements

• Associate's degree in a job-related field • Graduate of an Accredited School of Nursing may satisfy the degree equivalency • 5 years of clinical or utilization review/medical review experience, including 3 clinical years • 1 year in a team lead/leadership role or equivalent military experience in grade E4 or above; may be concurrent with the 5 years • Working knowledge of word processing, spreadsheet, and database software • Ability to work independently, prioritize effectively, and make sound decisions • Working knowledge of managed care and/or various forms of health care delivery systems • Strong clinical experience including home health, rehabilitation, and/or broad medical-surgical experience • Knowledge of specific criteria/protocol sets and their use • Good judgment, customer service, organizational, presentation, spelling, punctuation, and grammar skills • Ability to persuade, negotiate, or influence others • Analytical or critical thinking skills • Ability to handle confidential or sensitive information with discretion • Ability to lead, motivate, and assess performance of others • Microsoft Office proficiency • Active, unrestricted RN licensure from the United States and in the state of hire, or an active, compact multistate unrestricted RN license under the Nurse Licensure Compact • Preferred: Bachelor's degree in nursing (BSN), Master's degree in nursing (MSN), or MSN in Nursing Education; additional clinical experience may be considered in lieu of preferred education • Preferred: 3 years of utilization/medical review, quality assurance, or home health experience, plus 5 years of clinical experience • Preferred experience with PA & RCD Programs, FISS, and MCS • Preferred knowledge of spreadsheet and database software, Medicare regulations/policies/instructions/provisions, home health, and medical review system/processing procedures • Preferred working knowledge of Microsoft Excel, Access, or other spreadsheet/database software

🏖️ Benefits

• Subsidized health plans • Dental and vision coverage • 401k retirement savings plan with company match • Life Insurance • Paid Time Off (PTO) • On-site cafeterias and fitness centers in major locations • Education Assistance • Service Recognition • National discounts to movies, theaters, zoos, theme parks and more • Training classes and programs that help employees prepare for leadership positions • Tuition assistance for education advancement • Awards and financial incentives