Medical Review Manager
Accenture Federal Services•Baltimore, WA
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.
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.
- 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
- hands-on experience
- certifications
- industry training
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What This Job Offers
Job Type
Full-time
Career Level
Manager
