Medical Review Manager

Accenture Federal Services, a technology company within global Accenture, serves the US federal government across defense, national security, public safety, civilian, and military health organizations. The Medical Review Manager (MRM) serves as a primary liaison between CMS and the Contractor. The Medical Review Manager plans, implements, quality-checks, and evaluates CMS-directed medical review projects and oversees clinical review auditors. The company accepts applications on an on-going basis and there is no fixed deadline to apply.

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; Plan, implement, quality-check, and evaluate CMS-directed medical review projects; Oversee 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; 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; Work authorization in the United States that does not now or in the future require sponsorship of a visa for employment authorization

Benefits

Accenture Federal Services offers a wide variety of benefits