Federal Medical Review Lead

Accenture Federal Services; Washington; Presencial; USD 98.000 - 197.000; Jornada completa

Descripción de la vacante

Accenture Federal Services seeks a Medical Review Manager (MRM) to act as CMS’s primary liaison for MR programs, overseeing quality and methodology of medical reviews. This role requires extensive clinical and medical review experience, with strong knowledge of Medicare rules and documentation standards.

You will lead the MR projects, collaborate with the Medical Director, and ensure compliance with CMS requirements while guiding a team of reviewers across multiple settings.

Formación

• Minimum 5 years of clinical experience in acute care, skilled nursing, or office/clinic settings.
• Minimum 5 years of previous medical review experience.
• Minimum 3 years of management experience.
• Extensive knowledge of Medicare program, coverage and payment rules.
• Experience with medical review processes and documentation.

Responsabilidades

• 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 CMS requirements.
• Provide continuous quality oversight and ensure proper documentation, methodology, and reviewer accuracy.

Conocimientos

Clinical experience

Medical review experience

Management experience

Medicare knowledge

Medical terminology

Medicare claims analysis

Clinical review judgment

Educación

RN licensed in US

Master’s in nursing or related field OR BSN with experience

Descripción del empleo

Accenture Federal Services seeks a Medical Review Manager (MRM) to act as CMS’s primary liaison for MR programs, overseeing quality and methodology of medical reviews. This role requires extensive clinical and medical review experience, with strong knowledge of Medicare rules and documentation standards.

You will lead the MR projects, collaborate with the Medical Director, and ensure compliance with CMS requirements while guiding a team of reviewers across multiple settings.