[Hiring] Medical Review Supervisor @CoventBridge Group

Role Description

This position is responsible for the management of the Managed Care Project (MCP) in the Medical Review (MR) Department under the direction of the Medicaid Managed Care Project Manager. The MR Supervisor oversees all medical review activities for the MCP, and coordinates with the program integrity supervisors to make sure that all appropriate actions are completed in a timely manner.

In assuming this position, you will be a critical contributor to meeting CoventBridge Integrity System's objective: To provide services to our clients that exceed their expectations and contribute to improved health-care delivery by identifying and eliminating fraud, waste and abuse.

This position will report directly to the Medical Review MCP Project Manager and will work in our Grove City, OH office. If not local, remotely from a home office.

Responsibilities

• Develop, approve, implement, and ensure department compliance with Medical Review policies and procedures
• Assess results of MCP reviews conducted by Medical Review Nurses and ensure quality reviews are delivered to PI
• Assist in coordination of workflow between PI and MR staff as needed
• Ensure the MR department’s compliance with quality management system and ISO requirements
• Monitor and manage the quality of reviews and department productivity to meet CMS and UPIC management expectations
• Ensure that claim reviews meet the standards defined by the Statement of Work, Program Integrity Manual, and CMS directives and regulations pertaining to Medical Review
• Make hiring decisions regarding new MR employees and manage the existing Medical Reviewer staff
• Determine the necessary education and training for the department and ensure that it is provided to and attended by MR staff
• Produce and submit required reports according to established content and time limits
• Effectively communicate with the customer, stakeholders, and employees
• Perform other projects and responsibilities as assigned by the Project Manager and/or the Medical Review Manager

Qualifications

• Must be a Registered Nurse (RN) with an active license in the state of residence
• Preference given to candidates that have a Bachelor of Science Degree in Nursing
• Minimum of three years in a supervisory/management position
• Minimum of four years clinical experience in a medical/surgical setting is preferred
• Minimum of four years’ experience in medical/utilization review or fraud investigation preferred
• Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program
• Must have no unmitigated conflict of interest (COI)

Requirements

• Effective interpersonal, problem solving and communication (both written and verbal) skills
• Ability to work with others in a team environment
• Working knowledge of Microsoft Word, Excel, and Internet applications

Benefits

• Medical, Dental, Vision plans
• Life, LTD and STD paid by the employer
• 401(k) with company match up to 4%
• Paid Time Off and company paid holidays
• Tuition assistance after 1 year of service