Medical Claims Review Manager jobs in Massachusetts

Medical Claims Review Manager oversees the performance, productivity, and quality of the medical claims review staff. Responsible for hiring, training, and firing medical claims review staff. Being a Medical Claims Review Manager evaluates medical claims review processes and recommends process improvements. Serves as a technical resource for all medical review workers. Additionally, Medical Claims Review Manager typically requires an RN or BSN. Requires a bachelor's degree. Typically reports to a head of a unit/department. The Medical Claims Review Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Medical Claims Review Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)

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Manager, Medical Review
  • Sarepta Therapeutics
  • Cambridge, MA FULL_TIME
  • The Manager, Medical Reviewer provides operational oversight of medical materials review within the Medical Affairs function reporting to the Director of Global Medical Review. This individual works closely and effectively with key members of internal departments including Marketing, Legal/Compliance, Regulatory, Medical Affairs and Clinical Development to assure that all materials, both promotional and medical, meet the rigorous standards of scientific accuracy, objectivity, and fair balance. This person serves on cross functional teams, representing medical affairs.

    Primary Responsibilities Include:

    • Provide timely, medically relevant, scientifically sound, and fair-balanced medical/scientific reviews of materials submitted to medical and promotional review.
    • Responsible for providing oversight of the review of promotional and medical materials for scientific/medical validity across Sarepta's Portfolio.
    • Represent medical affairs in global cross-functional team meetings.
    • Critically review and provide solutions to complex promotional and medical pieces to ensure balance of the messages, medical accuracy, and appropriateness of the content of the materials/activities in accordance to scientific communication and with relevant guidance across Sarepta.
    • Proactively cultivate and grow strong relationships with cross-functional leads and other stakeholders to provide medical guidance in the development of scientific materials and resolve issues or concerns in promotional and medical review.
    • Leverage defined metrics and other tools to improve team performance and ensure adequate resource allocation.
    • Determine acceptability of data/references used to support promotional claims and provide expert guidance as well as effective negotiation leading to resolution for approval of pieces.
    • Address any scientific decision support needs from inquiries coming into Sarepta.
    • Maintains in-depth understanding of the disease state, product, competitors, marketplace, related medical areas, and regulatory guidelines.
    • Participate in the creation of, and ensure adherence to, departmental and corporate policies and SOPs and constantly look for places where process improvements would enhance the workflow.
    • Support commercial planning and launch planning activities including training materials, and medical information to provide scientific and medical support for publications and presentations.
    • Monitor the medical literature for Sarepta product(s) and relevant competitor data; analyzes the information for accuracy and relevance and appropriately synthesizes the data for inclusion in materials under review.
    • Collaborate with commercial operations, marketing, and regulatory operations to support the creation and submission of marketing materials and documentation to regulatory agencies.
    • Collaborate with Global Medical Communications and Medical Information to align with scientific information, establishing consistent communication.
    • Assist in driving consistency in medical information and communications, establishing one medical voice internally and externally.
    • Participate in internal and external meetings (training, educational and others, including medical congresses) to remain current on ever changing regulations, relevant new medical/scientific information and commercial strategy.
    • Other related duties as needed.

    Desired Education and Skills:

    • Advanced clinical/scientific degree: PharmD, PhD with 2 years of experience, preferably in medical affairs.
    • Scientific expertise in rare disease and gene therapy a plus.
    • Prior knowledge of the medical review process, experience as a medical reviewer a plus.
    • Excellent interpersonal, written, and verbal communications skills are essential to establish cross functional relationships.
    • High degree of accuracy; eye for detail, fastidious.
    • Ability to effectively manage time while balancing numerous high priority projects with a sense of urgency.
    • Must be a strong team player and be willing to work in an environment where individual initiative and accountability to the team are required.
    • Self-motivated with exceptional follow through.
    • Demonstrates flexibility in response to changing needs and competing demands.
    • Recognized by former peers, colleagues, managers and direct reports for attributes congruent with Sarepta Values: patients first, unconventional thinking, bias to action, integrity and talent.

    #LI-Remote

    This position is remote. However, you will be expected to work on site at one of Sarepta's facilities in the United States and/or attend Company-sponsored in-person events from time to time.

    Candidates must be authorized to work in the U.S.

    Sarepta Therapeutics offers a competitive compensation and benefit package.

    Sarepta Therapeutics is an Equal Opportunity/Affirmative Action employer and participates in e-Verify.

     

  • 1 Month Ago

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Learning Program Manager
  • Solutions Review
  • Woburn, MA FULL_TIME
  • We are seeking a highly motivated and experienced online learning program manager to design, develop, and deliver cutting-edge learning experiences with our IT community platform InsightJam.com in the...
  • 3 Days Ago

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Account Executive, Outside Sales
  • Veritas Medical Evaluation & Review
  • Winchester, MA FULL_TIME
  • Veritas Medical Evaluation & Review is growing and we are looking for motivated, confident, detail-oriented professionals. If you are interested in entering the medical record review and independent m...
  • 8 Days Ago

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Per diem Case Manager with Utilization Review experience - Hospital at Home Program
  • Lahey Hospital and Medical Center
  • Burlington, MA PER_DIEM
  • When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Job Type: Per Diem Scheduled Hours: 0 Work Shift: Day (United States of America) Joint ...
  • Just Posted

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Senior Manager of TPL Claims Programs- Hybrid
  • UMass Chan Medical School
  • Shrewsbury, MA FULL_TIME
  • The Benefit Coordination and Recovery (BCR) team is seeking a Senior Manager who will oversee department operations, contract management, and revenue and recovery projects. Under the general direction...
  • 17 Days Ago

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Sr Manager TPL Programs, Coordination of Benefits (COB) Claims Processing (hybrid)
  • University of Massachusetts Medical School
  • Shrewsbury, MA OTHER
  • Overview Under the general direction of the Associate Program Director or designee, the Sr Manager, TPL (Third Party Liability) Programs is responsible and accountable for managing TPL program areas, ...
  • Just Posted

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Hospital Medical Leader
  • Petco
  • Folsom, CA
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 6/10/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Alameda, CA
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 6/9/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Fairfield, CA
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 6/9/2024 12:00:00 AM

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Head of Medical Writing
  • Barrington James
  • Clinical-stage biopharmaceutical company in San Francisco, is seeking a Head of Medical Writing. This leadership role in...
  • 6/8/2024 12:00:00 AM

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Head of Medical Strategy
  • ExecuSearch
  • Atlanta, GA
  • The Head of Medical Strategy provides medical expertise to the rheumatology commercial and medical teams and provides cl...
  • 6/8/2024 12:00:00 AM

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Head of Medical Strategy Rheumatology
  • UCB
  • Atlanta, GA
  • Make your mark for patients The Head of Medical Strategy provides medical expertise to the rheumatology commercial and m...
  • 6/8/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Pinellas Park, FL
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 6/8/2024 12:00:00 AM

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Head of Medical Writing
  • Barrington James
  • San Francisco, CA
  • Head of Medical Writing - Rare disease Biotech We are currently partnered with a growing, west coast based biotech focus...
  • 6/7/2024 12:00:00 AM

Massachusetts is the 7th-smallest state in the United States. It is located in the New England region of the northeastern United States and has an area of 10,555 square miles (27,340 km2), 25.7% of which is water. Several large bays distinctly shape its coast. Boston is the largest city, at the inmost point of Massachusetts Bay, and the mouth of the Charles River. Despite its small size, Massachusetts features numerous topographically distinctive regions. The large coastal plain of the Atlantic Ocean in the eastern section of the state contains Greater Boston, along with most of the state's po...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$106,650 to $135,981

Medical Claims Review Manager in Parkersburg, WV
This end-to-end e-billing and e-payment solution is fully integrated with DecisionPoint, which means it can be immediately and easily integrated with your providers, adjusters, IT infrastructure, and claims workflow—enabling you to.
January 01, 2020
Medical Claims Review Manager in Juneau, AK
Examples include a claims examiner’s view of a particular bill’s status in a claim record’s related bill screen, or a bill review analyst’s view of an available reserve amount for the claim record related to the bill they are processing.
December 03, 2019
Medical Claims Review Manager in Galveston, TX
Assists the Manager, Medical Review with performing duties to oversee day-to-day activities within the Medical Claims Review Department to facilitate the achievement of business goals and targets.
December 16, 2019