Case Review Manager Quality

Veteran Benefits Guide•Enterprise, NV

2d•Onsite

About The Position

Veteran Benefits Guide (VBG) is seeking a Case Review Manager, Quality to lead, manage, and oversee the Case Review Team. This team is responsible for reviewing claims before submission to the Department of Veterans Affairs (VA) to ensure quality, accuracy, consistency, and adherence to established requirements. The role involves ensuring team quality and productivity, providing technical leadership, coaching team members, identifying process improvement opportunities, and collaborating cross-functionally. The Case Review Manager will translate quality findings and performance data into actionable recommendations to enhance claim quality, operational performance, and the Veteran experience. The ideal candidate will have strong knowledge of the VA disability claims process, analytical skills, leadership experience, and the ability to coach and develop a team in a fast-paced environment.

Requirements

Comprehensive knowledge of the VA disability claims process, including complex claims.
Strong understanding of DBQs, RDLs, and claims-related medical terminology.
Ability to analyze RDLs, identify potential errors, and provide guidance on complex claims.
Demonstrated leadership experience, including coaching, mentoring, and managing employees.
Strong analytical, critical-thinking, problem-solving, and attention-to-detail skills.
Strong written and verbal communication skills.
Ability to collaborate effectively across departments and organizational levels.
Strong organization, time management, and prioritization skills.
Ability to adapt to changing priorities and work effectively in a fast-paced environment.
Proficiency with Microsoft Office and applicable business systems and technology.
High school diploma or equivalent required.
Minimum 3 years of management experience.
Strong understanding of VBG policies, procedures, systems, and practices is required.

Nice To Haves

Bachelor’s degree in Business Administration, Healthcare Administration, or related field preferred.
Experience in VA disability claims, Case Review, Quality, or a related function preferred.
Experience with quality metrics, audits, performance management, and process improvement.
Internal candidates must have a minimum of two years of tenure with VBG.
Internal candidates must have been in their current role for at least six months.

Responsibilities

Lead and provide operational oversight of the Case Review Team.
Manage team workload, capacity, priorities, and workflow to meet quality, productivity, and timeliness goals.
Ensure Case Review activities follow VBG SOPs, policies, quality standards, and applicable VA requirements.
Provide technical guidance and serve as an escalation point for complex cases and quality concerns.
Monitor and analyze quality, productivity, timeliness, workload, and capacity metrics.
Review audit findings and performance trends to identify risks, root causes, and improvement opportunities.
Translate quality findings into coaching, training, corrective actions, and process improvements.
Recruit, onboard, coach, develop, and evaluate team members.
Identify training needs and support employee career development and succession planning.
Partner with POD Managers and other leaders to address performance and behavioral concerns.
Facilitate regular team meetings and communicate priorities, process changes, and organizational updates.
Collaborate cross-functionally to identify root causes and implement solutions that improve quality and operational performance.
Provide leadership with quality insights, trends, and actionable recommendations.
Identify opportunities to improve the effectiveness, efficiency, consistency, and scalability of the Case Review function.
Promote a culture of accountability, collaboration, continuous learning, and quality improvement.
Perform other duties and responsibilities as assigned.