Medical Review Manager

Saratoga Medical Center; Catonsville (MD); On-site; USD 95,000 - 125,000; Full time

Job summary

Saratoga Medical Center in Catonsville, MD is seeking a Medical Review Manager to lead the nurse review team and oversee CERT accuracy review activities within CMS-supported programs. The ideal candidate holds an RN license, board certification, at least five years of clinical practice, and two years of supervisory experience with Medicare rules; prior MR experience with MACs or CERT is preferred.

This role offers regular weekday hours and collaboration with program staff to ensure compliant

Qualifications

• RN licensed in the United States with board certification in nursing.
• Minimum five years as an RN in hospital, SNF, or clinic setting.
• At least two years of supervisory experience with Medicare rules.
• Experience with MR processes for MACs, CERT, SMRC, or RRB MAC preferred.

Responsibilities

• Supervise the Nurse Review staff.
• Develop, oversee, and implement CERT accuracy medical review processes.
• Collaborate with the Program Manager, CMD, and other contract staff.

Skills

Leadership

CMS/MAC knowledge

Nursing supervision

Regulatory compliance

Education

RN license (US)

Board Certified in Nursing

Tools

CERT knowledge

Medicare program guidelines

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Medical Review Manager

30+ days ago Requisition ID: 1353

Saratoga Medical has an immediate opening for a Medical Review Manager for a program supporting the Centers for Medicare and Medicaid Services (CMS) in Catonsville, MD. The work hours are Monday to Friday from 8:30 am to 5:00 pm.

Qualifications:

• Board Certified in Nursing and licensed to practice nursing in the U.S. and a currently licensed RN
• Minimum of five years of experience practicing as an RN in either an acute hospital, skilled nursing facility, or an office/clinic-based medical practice
• Minimum of two years of experience of supervisory experience with Medicare's program coverage and payment rules
• Experience in MR processes of Medicare Administrative Contractors (MACs), CERT, Supplemental Medical Review Contractor (SMRC), or Railroad Retirement Board (RRB) MAC is preferred

Responsibilities:

• Supervise the Nurse Review staff
• Development, oversight, and implementation of the CERT accuracy medical review processes while supervising the medical review nurses
• Collaborate with the Program Manager, CMD, and other contract staff

Saratoga Medical Center, Inc. is an equal opportunity employer and will not discriminate in recruiting, hiring, training, promotion, transfer, discharge, compensation or any other term or condition of employment on the basis of race, religion, color, age (over age 39), sex, national origin, or on the basis of disability if the employee can perform the essential functions of the job, with a reasonable accommodation if necessary.