Itemization Review Manager

CERIS; Fort Worth (TX); On-site; USD 65,000 - 95,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Paid Time Off

Parking

Job summary

CERIS, a division of CorVel Corporation, is seeking an Itemization Review Manager in Fort Worth, TX. You will oversee daily production flow for the Medical Review group and mentor nursing staff while coordinating with account managers and leadership.

The role requires an RN license in Texas, an associate nursing degree, and at least 1 year as an Itemization Review Nurse, with additional certifications preferred. A strong focus on accuracy, accountability, and teamwork is essential.

Qualifications

• Associate degree and current RN license in Texas are required.
• Bachelor's or Master's degree in nursing preferred.
• Experience as an Itemization Review Nurse for at least 1 year.
• Additional certifications in nursing, business management and medical bill review preferred.

Responsibilities

• Manage daily file flow into Medical Review and monitor potential overflow from other departments.
• Write performance evaluations for direct reports for annual review by EBR Manager.
• Ensure quality of SOA review results with a low error rate each month.
• Handle HR matters for department staff and mentor underperformance or attendance issues.

Skills

Verbal communication

Written communication

Multitasking

Microsoft Office

Nursing knowledge

Customer service

Education

RN license in TX

Associate degree in Nursing

Bachelor’s or Master’s in Nursing preferred

Tools

Microsoft Excel

HRIS systems

Job 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.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

• 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 attendanceof 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

KNOWLEDGE & SKILLS:

• Excellent verbal and written communication skills
• Ability to remain poised in stressful situations and communicate diplomatically viadifferent 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

EDUCATION & EXPERIENCE:

• 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
• Additional certifications in nursing, business management and medical bill review preferred

PAY RANGE:

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

ABOUT CERIS:

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!).

A comprehensive benefits package is available for full-time regular employees and includes 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, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.