Medical Review Manager

Job Description:

• Serve as CMS’s primary point of contact for medical review program activities
• Collaborate with the Contractor Medical Director to manage, evaluate, and ensure quality of all medical review 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
• Plan, implement, quality-check, and evaluate CMS-directed medical review projects
• Oversee clinical review auditors

Requirements:

• 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 the 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
• Must be a 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
• 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

Benefits:

• Collaborative and caring community
• Hands-on experience
• Certifications
• Industry training
• Wide variety of benefits
• Reasonable accommodations for disabilities or religious observances