Medical Review Manager

This is a fully remote position, open to applicants in District of Columbia, +2 more states.

📋 Description

• Act as the main contact for CMS regarding medical review program activities.

• Work in conjunction with the Contractor Medical Director to manage, assess, and guarantee the quality of all medical review initiatives.

• Direct, coordinate, and supervise medical review tasks in alignment with all CMS regulations.

• Ensure ongoing quality oversight while maintaining appropriate documentation, methodologies, and accuracy of reviewers.

• Plan, execute, quality-check, and assess medical review projects directed by CMS.

• Supervise clinical review auditors.

⛳️ Requirements

• At least 5 years of clinical experience in an acute care hospital, skilled nursing facility, or office/clinic-based medical practice.

• A minimum of 5 years of prior medical review experience.

• At least 3 years of management experience.

• In-depth knowledge of the Medicare program, including coverage and payment regulations.

• Comprehensive understanding of medical review processes.

• Strong grasp of medical terminology.

• Extensive knowledge of analysis and processing of Medicare claims.

• Profound understanding of clinical review judgment.

• Must possess a Registered Nurse license in a U.S. state, D.C., Puerto Rico, or U.S. territory.

• A Master’s degree in nursing or a related field, or a Bachelor’s in nursing along with the necessary relevant experience.

• Candidates seeking employment in the U.S. must hold work authorization that does not currently or will not in the future require visa sponsorship for employment authorization in the United States.

🏝️ Benefits

• Collaborative and supportive community.

• Practical experience.

• Certifications.

• Industry training.

• A diverse range of benefits.

• Reasonable accommodations for disabilities or religious observances.