Medical Review Manager

🕒 October 10

🏛️ District of Columbia, Maryland, +1 more states – Remote

🏛️ District of Columbia – Remote 🦀 Maryland – Remote ⚔️ Virginia – Remote

💵 $98.1k - $197.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Accenture Federal Services

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 2017

💼 Consulting

🎖️ Defense

📦 Logistics

Consulting • Defense • Logistics

Accenture Federal Services is a division of Accenture that focuses on delivering technology and consulting services to the U. S. federal government. With capabilities in cloud, cybersecurity, data and artificial intelligence, digital engineering, and emerging technologies, Accenture Federal Services supports federal agencies in achieving mission-critical outcomes through innovation and technological advancement. The company emphasizes building secure, scalable solutions, enhancing decision-making with data-driven insights, and transforming digital infrastructures to meet complex governmental needs. By leveraging advanced R&D and human-centered design, they aim to improve the performance and resilience of government operations.

📋 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

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