1 rn field case manager jobs found

The Policy and Payment Integrity Manager oversees the PPI team and assists with implementation of policies to perform reviews conducted by CERIS, including but not limited to itemized bill review, professional review, hospital outpatient and DRG validation. This role manages   members of the PPI team, developing team strengths and improving weaknesses, identifying team goals, and evaluating team progress. The Policy and Payment Integrity Manager provides trend analysis of internal auditing of claims for accuracy related to pre- and post-payment claims, targeted claims, high dollar claims, and any other claim or record that requires quality review. The role assists with development of internal quality assurance measures based on client policy and industry guidelines. The manager also aids in researching and implementing best practices related to (CMS) payment policies, healthcare policies, client, state, and/or policy initiatives. This is a remote role.   ESSENTIAL...