CMS Medical Review Lead - Nurse Manager

OpenKrill; United States; Remote; USD 98,000 - 197,000; Full time

Job summary

Accenture Federal Services is seeking a Medical Review Manager to serve as CMS’s primary liaison and to plan, monitor, and evaluate CMS-directed medical review projects. You will oversee clinical reviewers and coordinate with the Medical Director to maintain quality and compliance across MR activities.

The role requires substantial clinical experience, extensive Medicare knowledge, and proven management abilities.

Qualifications

• Minimum 5 years of clinical experience in acute care, skilled nursing, or clinic settings.
• Minimum 5 years of medical review experience and 3 years in management.
• Strong knowledge of Medicare rules, medical review processes, and claims analysis.

Responsibilities

• Serve as CMS’s primary point of contact for MR program activities.
• Collaborate with the Contractor Medical Director to manage MR projects and ensure quality.
• Lead and oversee medical review activities in accordance with CMS requirements.
• Provide ongoing quality oversight and document methodologies and reviewer accuracy.

Skills

Clinical experience

Medicare knowledge

Medical review

Management experience

Healthcare compliance

Education

RN license (US)

Master's in Nursing

Bachelor's in Nursing

Job description

Accenture Federal Services is seeking a Medical Review Manager to serve as CMS’s primary liaison and to plan, monitor, and evaluate CMS-directed medical review projects. You will oversee clinical reviewers and coordinate with the Medical Director to maintain quality and compliance across MR activities.

The role requires substantial clinical experience, extensive Medicare knowledge, and proven management abilities.