[Hiring] Itemization Review Manager @CERIS

Role Description

The Itemization Review Manager is responsible for managing daily production (file flow) of designated department, which may include one or more of the following functions: human resources, customer service, while promoting positive influence over professional review nurses within the EBR Medical Review group.

• Responsible for managing the daily file flow coming into Medical Review while maintaining awareness of potential file flow from other departments to track rush or special files, test files, or pilot studies for prospective clients.
• Writing performance evaluations for direct report staff for approval by EBR Manager on annual basis in accordance with company best practices.
• Responsible for quality of SOA review results for trainee-approved files; keeping own error ratio to less than 2% minimum on all approved files checked per month.
• Responsible for human resources matters directly related to department staff under direct supervision, including documentation of events or occurrences and verbal mentoring direct report staff when attendance or performance deficiencies are discovered.
• Responding to inquiries from internal customers within established time frame and indicating within the response when inquiry has been escalated and resolved by EBR Manager, directing further inquiries regarding the subject to the EBR Manager.
• Analyze data trends and daily counts to effectively manage workflow for nursing staff, and to respond correctly to questions received by the department from other CorVel offices, including account managers, upper management, and interdepartmental units within the Fort Worth office.
• Track the attendance of staff under direct supervision, in addition to ensuring adequate staffing levels during holiday seasons and peak times.
• Must be able to correctly respond to any on the job injury reported by staff members, and have thorough knowledge of the process for documentation and reporting in accordance with company procedures.
• Assist EBR Manager with their duties as needed.
• Assist with scheduling and initial screening of candidates for open positions, reporting on prospects to EBR Manager and submitting notes to assist EBR Manager in their final hiring decision.
• Participate in provider calls and meetings for designated clientele.
• May be required to travel overnight and attend meetings or training of various nurses in EBR Medical Review.
• May perform daily, weekly, monthly reviews of various reports, invoices, logs and expenses as directed by EBR Manager with assigned completion dates.
• Additional duties as assigned.

Qualifications

• Excellent verbal and written communication skills.
• Ability to remain poised in stressful situations and communicate diplomatically via different communication channels.
• Ability to skillfully manage multiple, complex projects and competing priorities concurrently while working under pressure to meet deadlines and maintaining strong customer service orientation.
• Computer proficiency and technical aptitude with the ability to utilize Microsoft Office including Excel spreadsheets.
• Thorough understanding of EBR Professional Review Nurse Responsibilities is necessary to accurately perform the functions of this position.
• Exceptional organizational skills.

Requirements

• Associate’s degree and current RN license in the State of Texas required.
• Bachelor’s or Master’s degree in nursing preferred.
• Experience as a Itemization Review Nurse for a minimum of 1 year.
• Previous supervisory experience a plus.
• Additional certifications in nursing, business management and medical bill review preferred.

Benefits

• Comprehensive benefits package available for full-time regular employees including:
• Medical (HDHP) w/Pharmacy
• Dental
• Vision
• Long Term Disability
• Health Savings Account
• Flexible Spending Account Options
• Life Insurance
• Accident Insurance
• Critical Illness Insurance
• Pre-paid Legal Insurance
• Parking and Transit FSA accounts
• 401K
• ROTH 401K
• Paid time off

Company Description

CERIS, a division of CorVel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).