Medical Review Manager
About The Position
The Medical Review Manager (MRM) serves as a primary liaison between CMS and the Contractor. Medical Review Manager plans, implements, quality‑checks, and evaluates CMS‑directed medical review projects and oversees clinical review auditors. At Accenture Federal Services, nothing matters more than helping the US federal government make the nation stronger and safer and life better for people. Our 13,000+ people are united in a shared purpose to pursue the limitless potential of technology and ingenuity for clients across defense, national security, public safety, civilian, and military health organizations. Join Accenture Federal Services, a technology company within global Accenture. Recognized as a Glassdoor Top 100 Best Place to Work, we offer a collaborative and caring community where you feel like you belong and are empowered to grow, learn and thrive through hands-on experience, certifications, industry training and more. Join us to drive positive, lasting change that moves missions and the government forward!
Requirements
- Minimum 5 years of clinical experience in one or more of the following settings: Acute care hospital, Skilled nursing facility, 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, Medical review processes, Medical terminology, Analysis and processing of Medicare claims, Clinical review judgment.
- Must be a Registered Nurse licensed in a U.S. state, D.C., Puerto Rico, or U.S. territory.
Nice To Haves
- Master’s degree in nursing or a related field OR Bachelor’s in nursing with required relevant experience.
Responsibilities
- 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.
Benefits
- Accenture Federal Services offers a wide variety of benefits.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
