Accenturefederalservices
Medical Review Manager
Baltimore, MD; Washington, DC. Posted a month ago
The role
The Medical Review Manager serves as a primary liaison between CMS and the Contractor. This person plans, implements, quality-checks, and evaluates CMS-directed medical review projects and oversees clinical review auditors.
What you will do
- Serve as CMS’s primary point of contact for MR program activities.
- Collaborate with the Contractor Medical Director to manage, evaluate, and ensure quality of all MR projects.
- Lead, coordinate, and oversee medical review activities in compliance with all CMS requirements.
- Provide continuous quality oversight and ensure proper documentation, methodology, and reviewer accuracy.
Required qualifications
- Minimum 5 years of clinical experience in an acute care hospital, skilled nursing facility, or office/clinic-based medical practice
- Minimum 5 years of previous medical review experience
- Minimum 3 years of management experience
- Extensive knowledge of Medicare program, including coverage and payment rules
- Extensive knowledge of medical review processes
- Extensive knowledge of medical terminology
- Extensive knowledge of analysis and processing of Medicare claims
- Extensive knowledge of clinical review judgment
- Registered Nurse licensed in a U.S. state, D.C., Puerto Rico, or U.S. territory
- Master’s degree in nursing or a related field OR Bachelor’s in nursing with required relevant experience
Benefits
- Certifications
- Industry training
- Hands-on experience
Before you apply
- Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States.
- Candidates who are currently employed by a client of Accenture Federal Services or an affiliated Accenture business may not be eligible for consideration.
About the company
Accenture Federal Services is a technology company within global Accenture that helps the US federal government. Its 13,000+ people work across defense, national security, public safety, civilian, and military health organizations.