Manager of Review Operations

A healthcare facility located in Brooklyn, NY is seeking an experienced and professional Manager of Review Operations. The individual who fills this role will be responsible for developing and implementing departmental initiatives and overseeing retrospective medical record reviews, both on-site and in provider settings. This is an excellent position for an individual who possesses strong leadership qualities with a multi-faceted, stable organization.

Healthcare Facility 

The Manager of Review Operations will be responsible for developing and implementing departmental initiatives and overseeing retrospective medical record reviews, both on-site and in provider settings. This will involve:

• Overseeing the categorizing and recording of each document associated with retrospective reviews in the appropriate system(s)
• Managing in-house staff, vendors and vendor contracts for retrospective review process
• Ensuring 95% or greater of appropriate determinations and recommendations for members based on established criteria including CAF/PRI compatibility, CM recommendations, and NHC recommendations
• Training and acting as a resource to all staff and making recommendations for changes in policy, procedures, and workflows as deemed appropriate

• 3-5 years of managed care experience in UR, QM, and/or medical necessity/coding review
• 2 years of supervisory experience
• Excellent organization skills

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• RN