The Claims Team Lead – Medical Management, is responsible for assisting with the oversight of a team of medical professionals. In this role, the Claims Team Lead – Medical Management will be responsible for department Quality Assurance, production, and workflow management. They will work closely with the Nursing Supervisor and Nursing Team Lead to ensure compliance standards are met.

RESPONSIBILITIES

• Monitor workflows and incoming treatment plan volume for a team of medical professionals to ensure regulatory deadlines and performance goals are met.
• Oversee Medical Management Compliance, evaluation of New Jersey specific regulations, training of staff, and evaluation of results to ensure the operation complies with all state requirements.
• Review and evaluate decisions made by Nurse Case Representatives and verify decisions made are within the standards of the Company’s Decision Point Review Plan and New Jersey AICRA requirements.