Clinical Bill Review and Treatment Plan Team Manager

Zurich Insurance is seeking a Clinical Bill Review and Treatment Plan Team Manager. This position is 100% remote.

 

The Clinical Bill Review and Treatment Plan Team Manager will be responsible for overseeing the team that reviews and evaluates medical bills and creates treatment plans for Zurich’s Workers Compensation claims.  The manager will ensure that the team is accurately reviewing medical bills and creating treatment plans to ensure that they are following policies, procedures, clinical guidelines, and jurisdictional requirements. The manager will also be responsible for managing and training the team members, managing the quality assurance program with our external vendors, and identifying areas for process improvement.

 

This fully remote position involves leading, managing and developing a team of multi-specialty Nurses.  The teams overall focus is on the handling of medical bills and treatment of Injured employees.

 

Key Responsibilities:

 

• Oversee day-to-day operations, including monitoring, leading, and directing the team in their day-to-day activities
• Managing the Quality Audit process with our external vendor
• Implement strategic plans to enhance managed care functions by evaluating and improving business processes and best practices
• Respond to all inquiries professionally and accurately by researching issues, determining root causes, and implementing solutions
• Lead and motivate a high-performance team, including attracting, onboarding, recruiting, and retaining team members
• Develop and implement process improvements to enhance efficiency
• Collaborate with Technical Claims teams to integrate managed care functions into the clinical bill review and treatment plan process
• Manage performance by setting job expectations, monitoring, and evaluating performance, providing feedback, and facilitating employee development
• Maintain transparent communication through regular meetings, emails, and interpersonal interactions
• Foster a workplace culture aligned with Zurich's mission, vision, and values
• Encourage continuous improvement in medical expertise within the team
• Protect Zurich’s reputation by maintaining confidentiality of claims information
• Stay current with industry trends through educational opportunities and networking
• Contribute to team efforts by participating in projects as needed

 

Basic Qualifications:

 

• Bachelor’s Degree and 3 or more years of experience in the Bill Review area, OR
• High School Diploma or Equivalent and 5 or more years of experience in the Bill Review area
• 2 or more years of management experience
• Knowledge of CPT and ICD-9 codes and medical terminology
• Proficiency with Microsoft Office

 

Preferred Qualifications:

 

• Master’s degree in Nursing or Health Care
• Bachelor’s Degree in Nursing and 3 or more years of experience in Bill Review and Case Management
• Knowledge of ODG, MTUS, State Guidelines

• Experience in developing and implementing cost containment programs.
• Certifications such as CRRN, CDMS, CCM, or COHN.
• 3-5 years of leadership experience in Nurse Case Management and Bill Review within a team setting
• Proficiency with Microsoft Office
• Some knowledge of Bill Review systems
• Experience managing and leading in a remote environment
• Workers Compensation Insurance industry experience
• Strong verbal and written communication skills

 

Compensation for roles at Zurich varies depending on a wide array of factors including but not limited to the specific office location, role, skill set, and level of experience. As required by local law, Zurich provides in good faith a reasonable range of compensation for roles. For additional information about our Total Rewards, click here. Other rewards may include short term incentive bonuses and merit increases. Candidates with salary expectations outside of the range are encouraged to apply, and will be considered based on experience, skill, and education. The salary provided is a nationwide market range and has not been adjusted for the applicable geographic differential associated with the location where the position may be filled. The starting salary range for this position is $96,300.00 - $157,700.00.

 
As a condition of employment at Zurich, employees must adhere to any COVID-related health and safety protocols in place at that time (https://www.zurichna.com/careers/faq).

 

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