Job details
Salary $66,921 - $110,068 a year job type full-time
Full job description
* position is eligible for remote / work from home opportunity *
Department: smrc
Telecommuting: yes
Paygrade: e13
Job title
Supervisor smrc medical review
Job summary
The supervisor supplemental medical review contractor (smrc) medical review provides guidance, leadership, planning, and reporting to appropriate individuals of the assigned medical review functionsThis position superivses staff to ensure the contract is administering the organization`s contracts with the best possible service and quality while maintaining contract expectations and within budget constraints while optimizing staffing levels.
Key performance indicators
Ability to lead and develop staff
Ability to lead project design and execute assigned projects
Ensures medical review (mr) goals are met
Essential functions
Key duties/responsibilities/accountabilities
Researches and provides guidance to develop and scope assigned projects to ensure compliance with the statement of work (sow), authorization forms, and manual guidance.
Writes professional, accurate, and effective project reports, reviews tools, and mentors others in business writing skills.
Requests, reviews, and provides recommendations based on data analysis results.
Collaborates with other team members to ensure the project progresses as expected.
Ensure the organization meets contractual obligations and performance standards.
Maintains a strong technical understanding of the system used to manage medicare business and the interrelationships between teams and system usage.
Serves as a subject matter expert (sme) for internal/external customers across multiple parts of medicare.
Serves as a point of contact to the centers for medicare & medicaid services (cms) and other external stakeholders.
Maintains knowledge and educates others on the sow including, but not limited to, operational work, reporting, and deliverables.
Coaches and develops clinical and frontline staff by encouraging growth and ensuring staff are meeting performance expectationsInitiates disciplinary action when performance does not meet expectations.
Leads by example by promoting team work, recognition, and leadership while demonstrating company values.
Participates in the budget process as appropriate and operates within and maintains knowledge of the mr budget.
May perform mr work in support of employees when needed.
Non-essential duties and functions
Other duties as assigned
Minimum qualifications
Registered nurse degree with active, unrestricted rn license
2 years` clinical experience in an acute care hospital, skilled nursing facility, and/or an office/clinic based medical practice and
2 years` experience in the medicare program or other payer experience
Exposure to medicare claims processing
Exposure to data analysis techniques and methodologies
Knowledge of fraud focused mr activities
Strong written and verbal communication skills
Demonstrated ability to research complex medicare regulations
Communicates accurate, concise information internally and externally
Ability to motivate and manage a large group of people
Ability to direct and maintain a productive and conducive working environment
Ability to coordinate activities among team
Ability to problem solve and develop problem solving skills within staff and self
Demonstrated proficiency in computer skills (e.gMicrosoft office suite, working in multiple windows, working in the shared systems)
Preferred qualifications
Above requirements and the following:
Bachelor`s degree in nursing or willing to obtain within established timeframe upon acceptance of the position
5 years` experience in the medicare program with exposure to multiple lines of business (a/b/dme)
2 years` experience working with fraud and mr activities
Strong understanding of nursing theory, techniques, practices and procedures, disease process and body systems, clinical diagnostic procedures and treatment, and skills in applying these to individual cases
Ability to analyze claims data for exposure trends
Experience completing root cause analysis using data trends to ensure quality operations
Demonstrated business writing skills
Ability to build effective interpersonal relationships within the workplace
Ability to effectively implement and champion change
Strong analytical skills and attention to detail
Maintains composure under pressure
Environment and cognitive/physical demands
Office environment
Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve
Requires prolonged sitting and telephone use
Requires the use of office equipment such as computer terminals, telephones, copiers and printers
Infrequent lifting to 15 pounds
Infrequent stooping
Travel up to 25%
Segregation of duties
Every employee is responsible to perform their duties and responsibilities in accordance with noridian values, policies and procedures, including but not limited to: segregation of duties principles, hipaa, security and privacy, cms requirements, the noridian compliance program and any other applicable laws, rules and regulations.
Statement of other duties
This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functionsEmployees may be requested to perform job related tasks other than those specifically listed in this description and may be required to perform any task requested by the supervisor or management.
Total rewards package:
Health, dental and vision insurance, voluntary insurance plans, health savings and flexible spending accounts, 401k and company match, company-paid life insurance, education assistance program, paid sick leave, paid holidays, increasing pto accrual plan, medical/parental/disability leave, workers compensation, retiree benefits, severance package, employee assistance program, financial and health wellness benefits, casual dress, open office setting, and online learning system.
Cms access compliance and regulation contingency statement
Some positions require compliance with (i) federal and agency specific regulations and related clauses included in noridian`s prime contracts with the government, (ii) background checks, and (iii) eligibility for a government-issued identification card.
Equal employment opportunity
Equal opportunity employer of minorities, females, protected veterans, and individuals with disabilities as well as sexual orientation or gender identity.
Other information
Job posting policy 6.05: new employees with noridian healthcare solutions will be eligible to apply for positions within their assigned department after successfully completing a 90-day reviewFor positions outside their department, they must attain a minimum of six months of service before they can apply.
Notice to colorado applicants:
Per colorado’s equal pay transparency rules act, below is the salary range for potential new hires that will be
Working/residing in the state of colorado.
Colorado salary range: $66,921.22 - $110,067.50
Other compensation: incentive plan
This job will be closed 10/07/2021 at 8:00am cstNo further applications will be considered.
Education
Required
Associates or better in nursing
Licenses & certifications
Required
Registered nurse
Equal opportunity employer/protected veterans/individuals with disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicantHowever, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information41 cfr 60-1.35(c)
