Clinical Adjudication Manager (Part C)

Tmf/C2C • Austin, TX

15h • Remote

About The Position

Manages project activities and participates in the development and monitoring of all related tasks. Manages medical and non-medical appeals decisions. This position is located Remote United States. This position requires working weekends, and rotating holidays as needed.

Requirements

• Associate’s degree or 60 or more credit hours towards a Bachelor’s degree from an accredited college or university in healthcare or related discipline
• Additional clinical or medical administration experience may be substituted for Associate’s degree on a year per year basis.
• Five (5) years conducting or overseeing Medicare appeals, medical review, or utilization management of Medicare claims.
• Three (3) years management or supervisory Healthcare Professional with one (1) year demonstrated experience writing, making, or overseeing Medicare related medical necessity decisions
• Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience

Nice To Haves

• Conducting or overseeing Medicare Part C related appeals activities, preferred

Responsibilities

• Plans and manages project activities to meet contract deliverables.
• Plans, manages, and develops a standardized approach for dissemination and communication of project information.
• Plans, manages, and develops presentations or instructional materials related to area of responsibility.
• Plans, prepares, and facilitates regular team meetings.
• Manages, trains, and evaluates project work activities and personnel.
• Manages the administrative processing of appeals/disputes and the coordination of workflow among internal staff and subcontractors.
• Manages, establishes, and maintains professional and effective working relationships with external business partners and internal staff.

Benefits

• Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
• Section 125 plan
• 401K
• Competitive salary
• License/credentials reimbursement
• Tuition Reimbursement

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Associate degree