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Salter Healthcare

RN Case Manager

Winchester, MA · On-site

$45 - $55/wk

Monitor level of care for HMO patients on admission and throughout their stay * Obtain prior approval for all HMO patients for transportation, therapy, and other services * Track HMO and Medicare ...

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Hmo information

What are the typical responsibilities of an HMO Medical Officer on a daily basis?

As an HMO Medical Officer, your daily tasks often include reviewing patient medical records for pre-authorization or claims, consulting with physicians and healthcare providers on case management, and conducting medical audits to ensure compliance with policies. You’ll also participate in utilization review meetings and help develop clinical guidelines to improve care quality and operational efficiency. This role is highly collaborative, requiring regular interaction with both clinical and administrative staff. By balancing clinical expertise with healthcare management, you play a key role in delivering effective and sustainable patient care within the HMO structure.

What is the highest paid job in health care?

In healthcare, anesthesiologists are among the highest-paid professionals, often earning over $300,000 annually due to their specialized skills and extensive training. Other high-paying roles include surgeons and certain medical specialists, which require advanced degrees, certifications, and years of experience.

What is an HMO job?

An HMO (Health Maintenance Organization) job typically refers to a role within a healthcare organization that provides managed care services to patients. Employees in HMO roles may work in various capacities, such as case management, claims processing, provider relations, or patient coordination. Their primary responsibility is to ensure efficient healthcare delivery while managing costs and maintaining compliance with healthcare regulations.

What jobs pay 4000 a week without a degree?

Jobs related to healthcare management, such as HMO coordinators or administrators, can sometimes pay around $4,000 weekly, especially with experience and certifications. Other high-paying roles without a degree include sales managers, real estate brokers, or skilled trades like electricians and plumbers, which often require specialized training or licensing but not a college degree.

What are the key skills and qualifications needed to thrive in the Hmo position, and why are they important?

To thrive as an HMO (Health Maintenance Organization) Medical Officer, a medical degree with appropriate licensure and experience in clinical medicine are essential. Familiarity with healthcare management systems, medical auditing tools, and utilization review protocols are typically required. Strong analytical thinking, decision-making, and interpersonal communication skills help HMO Medical Officers navigate complex cases and work collaboratively with providers and administrative teams. These competencies are vital for ensuring high-quality, cost-effective patient care and compliance with organizational standards.

What's the easiest healthcare job to get?

A healthcare job in the HMO sector that typically requires minimal formal education is a medical receptionist or administrative assistant, which often only needs a high school diploma and basic computer skills. These roles usually have lower entry barriers and may offer on-the-job training, making them easier to obtain compared to clinical positions that require certifications or degrees.

What is the job description of a HMO personnel?

A HMO personnel is responsible for managing health maintenance organization operations, including member services, claims processing, provider network coordination, and ensuring compliance with healthcare regulations. They often handle member inquiries, maintain records, and support administrative functions within the organization.
More about Hmo jobs
What are the most commonly searched types of Hmo jobs? The most popular types of Hmo jobs are:
What states have the most Hmo jobs? States with the most job openings for Hmo jobs include:
What job categories do people searching Hmo jobs look for? The top searched job categories for Hmo jobs are:
Hmo jobs near you
Infographic showing various Hmo job openings in the United States as of June 2026, with employment types broken down into 1% As Needed, 89% Full Time, 7% Part Time, and 3% Contract. Highlights an 89% Physical, 4% Hybrid, and 7% Remote job distribution.
Claims HMO - Claims Examiner 140-1028

Claims HMO - Claims Examiner 140-1028

CommunityCare

Tulsa, OK • On-site

Full-time

Posted 10 days ago

Job description

JOB SUMMARY:
The Claims Examiner is responsible for examining claims that require review prior to being adjudicated. The examiner will use their resources, knowledge and decision-making acumen to determine the appropriate actions to pay, deny or adjust the claim. Examiners are expected to meet performance expectations in accuracy and efficiency.
KEY RESPONSIBILITIES:
  • Examining and adjudicating claims that have pended for review utilizing resources, tools, knowledge and decision-making in determining appropriate actions.
  • Identify claims requiring additional resources and route to the team lead, supervisor or other departments as needed.
  • Enter claims information using the processing software to compute payments, allowable amounts, limitations, exclusions and denials.
  • Identify and communicate trends or problems identified during adjudication process.
  • Contribute to the creation of a pleasant working environment with peers and other departments.
  • Assist in investigating and solving claims that require additional research.
  • Consistently learn and adapt to changes related to claims processing, benefits, limits and regulations.
  • Perform other job-related duties as assigned.

QUALIFICATIONS:
  • Self-motivated and able to work with minimal direction.
  • Ability to read and understand claims processing manuals, medical terminology, CPT codes, and perform basic processing procedures.
  • Ability to read and understand health benefit booklets.
  • Demonstrated learning agility.
  • Successful completion of Health Care Sanctions background check.
  • Knowledge in the contracted managed care plan terms and rates.
  • General understanding of unbundling methods, COB, and other over-billing methodologies.
  • Must have high attention to detail.
  • Proficient in Microsoft applications.
  • Ability to perform basic mathematical calculations.
  • Possess strong oral and written communication skills.

EDUCATION/EXPERIENCE:
  • High School Diploma or Equivalent required.
  • Two years related work experience in claims processing, claims data entry or medical billing OR medical related education to meet minimum two years required.

CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

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