RN Team Coordinator - Clinical Review
Clinical Review Team in Virginia Beach, VA.
The instrumental leader in this role will provide responsibility, accountability and leadership for the daily operations of the Clinical Review team including the coordination of work, quality and service. The Clinical Review Team performs all post-service reviews, assists with updating and maintaining claims policies, assists Business Systems Integration (BSI) teams with claims processing, provides review for appeals and provides coding expertise to the entire organization. Assists with Clinical Care Services (CCS) policy changes and operationalizing changes as a result of coverage decisions. Minimum BSN degree required, previous supervisory experience and at least 3 years of case management.
Optima Health offers a full suite of commercial health insurance products including employee-owned and employer-sponsored plans, as well as Individual and Family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees. We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services.
As a nationally recognized provider of health plan coverage and innovative wellness programs, we live our mission “to improve health everyday.” This same commitment and dedication directs our philosophy as an employer. When you join Optima Health, you will experience our deep passion for heal and service excellence while benefiting from a culture of opportunity, learning, career growth, and support -every day. Optima Health is a service of Sentara Healthcare, so joining Optima is joining the Sentara Healthcare family.
Sentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For more information about our employee benefits, CLICK HERE!
Join our team, where we are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, growth!
Assumes responsibility, accountability and leadership for the daily operations including coordination of work, quality, and service. First line supervisor in the Department of Medical Care Management for assigned site/function. Facilitates the work of assigned team members. Provides a leadership role in ongoing case manager competency assessment, needs identification and educational offerings. Provides educational services to the Medical Care Management staff . Participates in the work activities of assigned teams and provides case management services as needed.
RN-Bachelor's Level Degree
Required: Case Management - 3 years
Preferred: Supervisory - Previous experience
Required: Registered Nurse
Preferred: Basic Life Support
Required: Communication, Critical Thinking, Service Orientation
For Integrated Care Management departments, specialty certification required within one year of eligibility (ACM, CCM, CCCTM or RN-BC). For other service lines, certification based on specialty area required within one year of eligibility. BLS (if in a clinical setting).
Strong coding background required.
Keyword: RN, Registered Nurse, Team Leader, Team Coordinator, Supervisor, Coding, Clinical Review, Health Plan, Claims
Equal Opportunity Employer