Itemization Review Manager

CorVel; Fort Worth (TX); Remote; USD 68,000 - 115,000; Full time

Job summary

An established industry player is seeking a dedicated Itemization Review Manager to lead their medical review team. This remote position requires overseeing personnel hiring, ensuring quality assurance, and maintaining production standards. You will play a crucial role in managing workflow, implementing new procedures, and identifying process improvements. The ideal candidate will possess strong problem-solving skills, attention to detail, and effective communication abilities. Join a company that values accountability and teamwork while offering a comprehensive benefits package and opportunities for career advancement.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401K

Paid Time Off

Flexible Spending Account

Life Insurance

Long Term Disability

Accident Insurance

Critical Illness Insurance

Qualifications

• RN license required with previous supervisory experience.
• Understanding of audit guidelines including CMS and payor policies.

Responsibilities

• Manage daily file flow and ensure quality review results.
• Track attendance and performance of direct report staff.

Skills

Problem Solving

Critical Thinking

Effective Communication

Attention to Detail

Team Orientation

Education

Associate Degree in Nursing

Bachelor's Degree in Nursing

Master's Degree in Nursing

Tools

Microsoft Office Suite

Job description

The Itemization Review Manager is responsible for the overall aspects of the medical review team including personnel hiring, quality assurance of product, workflow, maintaining the tracking of and accountability of staff regarding production standards and turn-around expectations.

This is a remote position.

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, pilot studies for prospective clients
• Writing performance evaluations for direct report staff on annual basis as per CorVel/CERIS guidelines
• Responsible for meeting client specific turnaround times and metrics
• Responsible for quality of review results and an error rate of less than 2% on all completed files per month
• Responsible for human resources matters directly related to department staff under direct supervision including documentation of events or occurrences and verbal counseling direct report staff when attendance or performance deficiencies are discovered
• Requires regular and consistent attendance and the tracking of attendance of staff under direct supervision, in addition to ensuring adequate staffing levels to meet business needs and productivity standards
• Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP)
• Responsible for implementing new procedures/protocols as necessary
• Responsible for identifying process improvement opportunities and reporting these to the director of audit
• Responsible for maintaining and updating department protocol library
• Responsible for monitoring various reports daily to ensure productivity metrics and client goals are met
• Assist with additional projects as requested
• Participate in provider and client calls as needed
• Participate in leadership calls as needed
• May be required to travel overnight to attend meetings and/or training
• Additional duties as assigned by director of audit and/or SVP of operations

KNOWLEDGE & SKILLS:
• Understanding of audit guidelines including CMS and payor policies
• Extreme attention to detail
• Must possess problem solving, critical thinking skills
• Must be team oriented
• Effective and professional communication skills, both verbal and written
• Ability to act in a professional manner with both internal and external customers
• Ability to think and work independently
• Ability to work in a fast-paced production environment
• Proficient in Microsoft Office Suite

EDUCATION & EXPERIENCE:
• Associate degree and current RN license required.
• Bachelor’s or master’s degree in nursing or other healthcare related field preferred
• Previous supervisory experience required
• Previous nurse audit or payment integrity experience 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.

Pay Range: $68,696 – $114,313

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

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.