Bill Review Nurse Case Manager — Hybrid/Remote

Summit; United States; Híbrido; USD 90.000 - 130.000; Jornada completa

Descripción de la vacante

Summit is seeking an experienced healthcare professional for a senior role in case management. The position requires an RN license, a bachelor’s degree in healthcare management or nursing, and at least 14 years in case management or managed care.

The role includes reviewing bills, negotiating pre-surgical services, and providing expert guidance to Claims staff. The role offers a mix of on-site and remote work, with core in-office days and flexibility based on business needs.

Formación

• RN required.
• 14+ years of case management or managed care experience.
• Must have bill review experience.

Responsabilidades

• Reviews facility and professional bills for appropriateness or inconsistencies.
• Negotiates pre-surgical services.
• Performs audits to identify leakage or improve processes.
• Provides professional advice to Claims staff on medical/cost-control procedures.
• Provides technical advice to lower-level staff and other areas.
• Assists with special projects as needed.
• May coach staff and participate in talent decisions for direct reports.
• Performs other duties as assigned.

Conocimientos

RN

Case management

Managed care

Leadership

Educación

Bachelor’s degree in Healthcare Management/Nursing/related field

Descripción del empleo

Summit is seeking an experienced healthcare professional for a senior role in case management. The position requires an RN license, a bachelor’s degree in healthcare management or nursing, and at least 14 years in case management or managed care.

The role includes reviewing bills, negotiating pre-surgical services, and providing expert guidance to Claims staff. The role offers a mix of on-site and remote work, with core in-office days and flexibility based on business needs.