RN Medical Review Manager (Home Health & Hospice)
CGS Administrators LLC | |
life insurance, paid holidays, tuition assistance, 401(k), remote work | |
United States, Georgia, Atlanta | |
Jan 03, 2025 | |
Summary We are looking for a Registered Nurse with strong leadership and analytical skills to guide our Home Health & Hospice Medical Review Team. Oversee the performance, productivity, and quality of the medical claims review staff. Team includes clinical medical reviewers and claims processor. Evaluate medical claims review processes and implements process improvements. Serves as a resource for all medical review team members. Coach, mentor, and develop staff. Ensures compliance with nationally recognized standards, and local, state, and federal laws and regulations. Responsible for the planning and development of the medical review strategy. Review claims data that includes activity reports and spreadsheets, to plan strategy, monitor and measure departmental productivity, goal achievement, and overall effectiveness.
Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we've been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! This open position is within one of our subsidiary companies called CGS Administrators. CGS has been a proven provider of administrative and business services for state Medicaid agencies, managed care organizations, commercial health plans, Medicaid members, Medicare beneficiaries, healthcare providers, and medical equipment suppliers for more than 50 years. Description Logistics:
What You Will Do
What You Need to Qualify
What We Prefer You Have
What We Can Do for You We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have access and opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. Our comprehensive benefits package includes:
What to Expect Next After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with the most qualified candidates. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Some states have required notifications. Here's more information. Equal Employment Opportunity StatementBlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or an accommodation while seeking employment, please e-mail mycareer.help@bcbssc.com or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. |