Manager, Complex Clinical Review

The role

The Manager oversees the Complex Clinical Bill Review team and manages production, SLAs, and team performance. This role involves managing a remote team of nurses and other audit roles to perform clinical review audits.

What you will do

• Oversee the Complex Clinical Bill Review team, managing production expectations, SLA’s, 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 problem solve for process-related issues.
• Manage team member’s current assignments and collaborate across teams to ensure SLAs are met.
• Oversee the development and application of clinical review concepts.
• Delegate tasks and responsibilities to team members and oversee special projects.
• Coordinate system enhancements including JIRA ticket creation, UAT testing, and production employment.
• Monitor team’s performance and track metrics to identify opportunities for growth and efficiency.
• Develop and coordinate training materials, quality assurance process, and dispute response workflows.

Required qualifications

• Current, unrestricted nursing license in good standing
• 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
• Strong project management and interpersonal skills
• Strong interpersonal skills for interfacing with all levels of internal and external audit teams and management
• Ability to prioritize and multitask
• Strong effective communicator, both orally and in writing
• Proven experience in managing high performing dynamic teams
• Ability to work in a diverse and fast paced environment

Nice to have

• 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

Benefits

• Full Medical/Dental/Vision for employees & their families
• Flexible and trusting environment
• Unlimited FTO
• Competitive salary
• equity
• 401(k) including employer match

About the company

Machinify is a healthcare intelligence company with expertise across the payment continuum. It delivers value, transparency, and efficiency to health plan clients using an AI-powered platform.