Medical Review Claims - Nurse Coordinator

Co-responsible for researching, creating, implementing, and maintaining all department processes and education / training material with regular team training sessions. Responsible for receiving, researching, answering all direct questions from employees and other departments / divisions regarding employee reviews / decisions.

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

Why Join Us?

• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
  
• Family Comes First: Total rewards package that promotes the idea of family first for all employees. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire
  
• Professional Growth Opportunities: Advance your career with ongoing training and development programs.
  
• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility.
  
• Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community.
  
• Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected.
  

Benefits & Perks

• Base compensation is only one component of your competitive Total Rewards package
  
  • Incentive pay program (EPIP)
    
  • Health/Vision/Dental insurance
    
  • 6 weeks paid parental leave for new mothers and fathers
    
  • Fertility/Adoption assistance
    
  • 2 weeks paid caregiver leave
    
  • 401(k) plan matching up to 5%
    
  • Tuition reimbursement
    
  • Health & fitness benefits, discounts and resources
    

Job Summary
The Medical Review Claims Nurse Coordinator directly oversees the day-to-day activities of a team of medical review nurse consultants. Co-responsible, with the other Coordinator and Analyst Supervisor, to research, develop, and implement all training / education materials for the entire Medical Review department. Responsible for ensuring employee production and quality meets department / company goals. Responsible for receiving, researching, answering all direct questions from employees and other departments / divisions regarding employee reviews / decisions. Lead multiple departmental meetings and projects. Participate in divisional meetings along with the Manager.

Work Location
This position is eligible to work remotely, hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.

What you'll do

• Accountable for performance monitoring, policy enforcement, termination process, disciplinary action, hiring, compliance and team development. Maintaining accurate records of all hiring, firing and disciplinary actions.
  
• Ensure supervised employees are compliant with all company, state, and federal regulations.
  
• Lead / participate in multiple cross division/department teams.
  
• Ensure all supervised employees maintain their clinical licensing and professional coder certifications.
  
• Co-responsible for researching, creating, implementing, and maintaining all department processes and education / training material with regular team training sessions.
  
• Accountable for identifying and researching production inconsistencies involving policy questions and other problem areas and present solutions to management.
  
• Subject matter expert for department, division, and senior management inquiries.
  
• Conduct regular audits and assessments of the claim review process to ensure accuracy, regulatory compliance, and identify areas for process improvement.
  
• Provide ongoing support and mentorship to staff, fostering professional development and growth.
  
• Accountable for independent approval of claims up to $1 million.
  
• Must follow URAC standards as required for essential job functions.
  

Education

• Bachelor's degree or equivalent in nursing or health related field required
  

Experience

• Minimum 6 years' experience in a clinical nursing role (Medical Review Claims experience counts) required
  
• Minimum 3 years' experience Medical Review Claims experience preferred
  
• Minimum 1 years' experience in a supervisor or leadership role preferred
  

Licenses and Certifications

• Current, active, unrestricted Kansas RN License required
  
• Certified Coder-AHIMA or AAPC within 3 years of hire required
  

Travel

• No travel
  

Knowledge, Skills and Abilities

• Must be able to effectively supervise a team with diverse personalities, educational backgrounds, and various management a