Medical Review Lead (RN) - CMS Compliance & Quality

Accenture Federal Services; Maryland; On-site; USD 98,000 - 197,000; Full time

Job summary

Accenture Federal Services seeks a Registered Nurse to serve as Medical Review Manager, acting as the CMS liaison and overseeing clinical review audits for MR programs. The role requires extensive Medicare knowledge and management experience across settings.

The MR ensures quality, documents methodologies, and maintains reviewer accuracy while coordinating with the Medical Director and CMS directives to advance federal mission objectives.

Qualifications

• Minimum 5 years of clinical experience in acute care, skilled nursing facility, or clinic-based practice.
• Minimum 5 years of medical review experience.
• Minimum 3 years of management experience.
• Extensive knowledge of Medicare program rules, medical review processes and terminology.

Responsibilities

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

Skills

Nursing

Clinical experience

Medicare knowledge

Medical review

Management experience

CMS liaison

Education

RN license (US state/DC/PR/territory)

Master’s degree in nursing or related field

Bachelor’s in nursing with relevant experience

Job description

Accenture Federal Services seeks a Registered Nurse to serve as Medical Review Manager, acting as the CMS liaison and overseeing clinical review audits for MR programs. The role requires extensive Medicare knowledge and management experience across settings.

The MR ensures quality, documents methodologies, and maintains reviewer accuracy while coordinating with the Medical Director and CMS directives to advance federal mission objectives.