Medical Policy Manager jobs in Tennessee

Medical Policy Manager manages and implements corporate policy and process for medical provider and other reimbursements. Ensures that all claims are reviewed, settled, and processed in compliance with and according to contract provisions and regulatory requirements. Being a Medical Policy Manager evaluates and develops policies and provider reimbursement guidelines to effectively manage and control medical claims cost. Requires a bachelor's degree of finance, business or healthcare administration. Additionally, Medical Policy Manager typically reports to head of a unit/department. The Medical Policy 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 Policy 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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Health Policy Data Analyst – Data Modeling
  • Vanderbilt University Medical Center
  • Vanderbilt, TN FULL_TIME
  • Discover Vanderbilt University Medical Center: Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery, and patient care, VUMC is a community of diverse individuals who come to work each day with the simple aim of changing the world. It is a place where your expertise will be valued, your knowledge expanded, and your abilities challenged. Vanderbilt Health recognizes that diversity is essential for excellence and innovation. We are committed to an inclusive environment where everyone has the chance to thrive and where your diversity of culture, thinking, learning, and leading is sought and celebrated. It is a place where employees know they are part of something that is bigger than themselves, take exceptional pride in their work and never settle for what was good enough yesterday. Vanderbilt’s mission is to advance health and wellness through preeminent programs in patient care, education, and research. Organization: Health Policy Job Summary: The Department of Health Policy is seeking qualified health policy data analyst candidates to provide support to faculty in the Center for Health Economic Modeling for complex quantitative and data modeling research projects in health policy, public health, or related disciplines under occasional faculty guidance. This position primarily develops and implements R-based mathematical modeling, including cost-effectiveness analysis and disease simulation modeling. The position utilizes intermediate-to advanced-level research and programming skills to perform a variety of quantitative research activities including data management, analysis of quantitative data, data visualization, and manuscript preparation. . Health Policy Data Analyst – Data Modeling (3951) – Department of Health Policy Job Summary: The Department of Health Policy is seeking qualified health policy data analyst candidates to provide support to faculty in the Center for Health Economic Modeling for complex quantitative and data modeling research projects in health policy, public health, or related disciplines under occasional faculty guidance. This position primarily develops and implements R-based mathematical modeling, including cost-effectiveness analysis and disease simulation modeling. The position utilizes intermediate-to advanced-level research and programming skills to perform a variety of quantitative research activities including data management, analysis of quantitative data, data visualization, and manuscript preparation. The ideal candidate will work well independently and in collaboration with multiple faculty members and projects simultaneously, take the initiative to gather suitable data to address policy questions, and complete assignments on time. In addition to coding and analyses in R, familiarity with Git, C /C#, and/or Python would also be highly valued. The responsibilities of this position will include highly quantitative and written data analysis on issues of current policy interest. Examples of projects may include: Modeling and evaluating the cost-effectiveness of medication options, new health technologies, or policy changes using disease simulation models Analyzing trends in health care expenditures for Medicare and Medicaid beneficiaries Examining policy options for improving the value of care delivered to patients in diverse settings Key Responsibilities: Data Management Responsible for managing large and/or complex datasets Develops datasets by performing data cleaning, data validation, and data reporting Maintains detailed documentation of data management and programming codes Ensures the integrity and security of data Health Policy Data Analysis Uses advanced statistical and data programming skills to manage and analyze data Summarizes and interprets complex statistical analyses Able to create, modify, and run multifaceted database queries and produce reports Expertise in data modeling and understands relationships between data items including R-based mathematic and statistical models (i.e., Markov, Microsimulation, Discrete-event simulation models) Creates complex charts, graphs, and tables to summarize analysis results Project Management and Presentation Uses intermediate-to-advanced quantitative research methods skills to participate in the design, coordination, and conduct of research projects Prepares materials and drafts technical sections of presentations and written documents Able to prepare effective presentations in content and function Fosters collaboration between team members, both internal and external to the department Minimum Qualifications: This position requires a master’s degree and two years of related experience. A degree in economics, statistics, computer science, or another field with quantitative coursework is strongly preferred. Preferred qualities and skills: Expertise with R and/or C /C# Strong quantitative, statistical, and data analysis skills Strong written and verbal communication skills Expertise in mathematic/disease modeling and/or health technology assessment Experience with health-related datasets and/or population surveys Knowledge of health policy issues Self-starter with good time management, initiative, and professional work style A current resume and cover letter must be included/uploaded in your online application to be eligible for consideration. Additional Information: This is a full-time position. Salary is dependent upon education and experience. Background screens will be performed and education will be verified prior to employment. Please be prepared to provide required information and/or documentation. Our Academic Enterprise is one of the nation’s longest serving and most prestigious academic medical centers. Through its historic bond with Vanderbilt University and integral role in the School of Medicine, Vanderbilt Health cultivates distinguished research and educational programs to advance a clinical enterprise that provides compassionate and personalized care and support for millions of patients and family members each year. World-leading academic departments and comprehensive centers of excellence pursue scientific discoveries and transformational educational and clinical advances across the entire spectrum of health and disease. Aligning with Vanderbilt Health’s Strategic Directions, the Office of Research provides shared research resources, administrative expertise and professional guidance to enable the trans-disciplinary environment and highly collaborative culture that advances discovery and training for all the research faculty, trainees, students and staff. Core Accountabilities: Organizational Impact: Executes job responsibilities with the understanding of how output would affect and impact other areas related to own job area/team with occasional guidance. Problem Solving/ Complexity of work: Analyzes moderately complex problems using technical experience and judgment. Breadth of Knowledge: Has expanded knowledge gained through experience within a professional area. Team Interaction: Provides informal guidance and support to team members. Core Capabilities : Supporting Colleagues:- Develops Self and Others: Invests time, energy, and enthusiasm in developing self/others to help improve performance e and gain knowledge in new areas.- Builds and Maintains Relationships: Maintains regular contact with key colleagues and stakeholders using formal and informal opportunities to expand and strengthen relationships.- Communicates Effectively: Recognizes group interactions and modifies one's own communication style to suit different situations and audiences. Delivering Excellent Services:- Serves Others with Compassion: Seeks to understand current and future needs of relevant stakeholders and customizes services to better address them.- Solves Complex Problems: Approaches problems from different angles; Identifies new possibilities to interpret opportunities and develop concrete solutions.- Offers Meaningful Advice and Support: Provides ongoing support and coaching in a constructive manner to increase employees' effectiveness. Ensuring High Quality: - Performs Excellent Work: Engages regularly in formal and informal dialogue about quality; directly addresses quality issues promptly.- Ensures Continuous Improvement: Applies various learning experiences by looking beyond symptoms to uncover underlying causes of problems and identifies ways to resolve them. - Fulfills Safety and Regulatory Requirements: Understands all aspects of providing a safe environment and performs routine safety checks to prevent safety hazards from occurring. Managing Resources Effectively: - Demonstrates Accountability: Demonstrates a sense of ownership, focusing on and driving critical issues to closure.- Stewards Organizational Resources: Applies understanding of the departmental work to effectively manage resources for a department/area.- Makes Data Driven Decisions: Demonstrates strong understanding of the information or data to identify and elevate opportunities. Fostering Innovation:- Generates New Ideas: Proactively identifies new ideas/opportunities from multiple sources or methods to improve processes beyond conventional approaches.- Applies Technology: Demonstrates an enthusiasm for learning new technologies, tools, and procedures to address short-term challenges.- Adapts to Change: Views difficult situations and/or problems as opportunities for improvement; actively embraces change instead of emphasizing negative elements. Position Qualifications: Responsibilities: Certifications : Work Experience : Relevant Work Experience Experience Level : Less than 1 year Education : Master's Vanderbilt Health recognizes that diversity is essential for excellence and innovation. We are committed to an inclusive environment where everyone has the chance to thrive and to the principles of equal opportunity and affirmative action. EOE/AA/Women/Minority/Vets/Disabled PEOPLE ARE AT THE HEART OF ALL WE DO. Our vision: The world leader in advancing personalized health. Our mission: personalizing the patient experience through our caring spirit and distinctive capabilities. Making Health Care Personal. We’re looking for like-minded individuals driven to make a difference. We invite you to explore careers at Vanderbilt University Medical Center. At VUMC, we place a priority on designing with and for our patients and families. We value collaboration, embrace continuous learning and discovery, and intentionally pursue diversity and inclusion. These are our guiding “Strategic Directions.” We’re the largest private employer in Middle Tennessee, with a growing team and expanding footprint in towns and communities across the region. We employ more than 28,000 people who work in inpatient and outpatient clinical care, research, and graduate medical education as well as critical supporting roles in administration, information technology and informatics, finance, legal and community affairs, communications and marketing, fund-raising, groundskeeping and facilities, and many more. Our growing health system has a total of 1,615 licensed hospital beds at: Vanderbilt University Hospital Monroe Carell Jr. Children’s Hospital at Vanderbilt Vanderbilt Psychiatric Hospital Vanderbilt Wilson County Hospital Vanderbilt Bedford Hospital Vanderbilt Tullahoma-Harton Hospital It’s also home to hundreds of outpatient clinic and surgical locations throughout the region. We serve our community with many unique and specialized services including the Level 1 Trauma Center, a highly experienced Transplant Center that does the most heart transplants in the world, a National Cancer Institute-designated Comprehensive Cancer Center, Lung Institute, Burn Center and many more. World-leading academic departments and centers make scientific discoveries, advance clinical care and train the next generation of health care professionals. Our robust research enterprise ranks No. 9 in the country as measured by peer-reviewed grant funding from the National Institutes of Health. We’re honored to be consistently considered among the nation’s best hospitals, including being nationally ranked in multiple medical specialties for treating the most complex conditions in adults and children by US News and World Report. The Children’s Hospital ranked as the No. 1 children’s hospital in the southeast in 2021. We support each other and encourage excellence among all who are part of our workforce. High-achieving employees stay at VUMC for professional growth, appreciation of benefits, and a sense of community and purpose — never stronger than during the challenging COVID pandemic. Join us in Making Health Care Personal.
  • 4 Days Ago

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Medical Education Manager
  • Music City Medical Technologies
  • Brentwood, TN FULL_TIME
  • Position SummaryThe Medical Education Manager is responsible for educating surgeons on the safe and effective use of the medical devices sold by Music City Medical Technologies, and for being a liaiso...
  • 2 Days Ago

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Medical Surgical Manager
  • TriStar Summit Medical Center
  • Hermitage, TN FULL_TIME
  • DescriptionIntroductionManagers thrive with us! HCA Healthcare is one of the nation’s leading providers of healthcare services, comprising of over 180 hospitals and about 2,000 sites of care in 21 sta...
  • 9 Days Ago

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Medical Surgical Manager
  • TriStar StoneCrest Medical Center
  • Smyrna, TN FULL_TIME
  • Introduction Want to join a team of daring managers who care without reservations or limits? Our TriStar StoneCrest Medical Center team is looking for a Medical Surgical Manager. HCA Healthcare is an ...
  • 17 Days Ago

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Manager Medical Surgical
  • TriStar Southern Hills Medical Center
  • Nashville, TN FULL_TIME
  • Introduction We are seeking a Medical/Surgical Manager with TriStar Southern Hills Medical Center to promote growth and unlock possibilities. At HCA Healthcare, we are committed to the care and improv...
  • 20 Days Ago

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Manager - Medical Staffing & Credentialing, FT, Days
  • North Knoxville Medical Center
  • Knoxville, TN FULL_TIME
  • Responsible for monitoring the verification process for medical staff incumbents. Completes physician, nurse and other employee verifications and ensures that the organization and staff are in accorda...
  • 23 Days Ago

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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

Tennessee borders eight other states: Kentucky and Virginia to the north; North Carolina to the east; Georgia, Alabama, and Mississippi on the south; Arkansas and Missouri on the Mississippi River to the west. Tennessee is tied with Missouri as the state bordering the most other states. The state is trisected by the Tennessee River. The highest point in the state is Clingmans Dome at 6,643 feet (2,025 m). Clingmans Dome, which lies on Tennessee's eastern border, is the highest point on the Appalachian Trail, and is the third highest peak in the United States east of the Mississippi River. The ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Policy Manager jobs
$121,727 to $148,604

Medical Policy Manager in Miami, FL
Each county may, under the Health & Safety Code, establish an Emergency Medical Care Committee (EMCC) with membership prescribed and appointed by the county board of supervisors.
January 02, 2020
Medical Policy Manager in Orange, CA
All Medical Device Licence holders or potential Medical Device Licence holders.
December 06, 2019
Medical Policy Manager in Fresno, CA
The Air Force has allowed more than 600 airmen to join its ranks despite having previously disqualifying medical conditions such as eczema and attention-deficit hyperactivity disorder, new statistics show.
December 29, 2019