Medical Review Manager

OpenKrill; United States; On-site; 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

At Accenture Federal Services, nothing matters more than helping the US federal government make the nation stronger and safer and life better for people.Our 13,000+ people are united in a shared purpose to pursue the limitless potential of technology and ingenuity for clients across defense, national security, public safety, civilian, and military health organizations.

Join Accenture Federal Services, a technology company within global Accenture. Recognized as a Glassdoor Top 100 Best Place to Work, we offer a collaborative and caring community where you feel like you belong and are empowered to grow, learn and thrive through hands‑on experience, certifications, industry training and more.

Join us to drive positive, lasting change that moves missions and the government forward!

The Medical Review Manager (MRM) serves as a primary liaison between CMS and the Contractor. Medical Review Manager plans, implements, quality‑checks, and evaluates CMS‑directed medical review projects and oversees clinical review auditors.

Primary 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.

Required Experience

- 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
• Medical review processes
• Medical terminology
• Analysis and processing of Medicare claims
• Clinical review judgment

Required Education

• 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 fieldOR
• Bachelor’s in nursing with required relevant experience.

As required by local law, Accenture Federal Services provides reasonable ranges of compensation for hired roles based on labor costs in the states of California, Colorado, Connecticut, Hawaii, Illinois, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New York, Ohio, Vermont, Virginia, Washington, and the District of Columbia. The base pay range for this position in these locations is shown below. Compensation for roles at Accenture Federal Services varies depending on a wide array of factors, including but not limited to office location, role, skill set, and level of experience. Accenture Federal Services offers a wide variety of benefits. You can find more information on benefits here. We accept applications on an on-going basis and there is no fixed deadline to apply.

The pay range for the states of California, Colorado, Connecticut, Hawaii, Illinois, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New York, Ohio, Vermont, Virginia, Washington, and the District of Columbia is:$98,100-$197,400 USD

What We Believe

As a company wholly dedicated to serving the US federal government, we bring together the best talent to help reinvent how federal agencies operate and deliver greater value for their mission and the American people. We have an unwavering commitment to creating a culture in which all our people are respected, feel a sense of belonging, and have equal opportunity. As a business imperative, every person at Accenture Federal Services has the responsibility to create and sustain a culture where everyone feels welcomed and included. This is grounded in our core values and our experience that hiring and developing great people who reflect different perspectives, experiences, and backgrounds is key to driving innovation and delivering the results that our clients and the country count on.

Equal Employment Opportunity Statement

We believe that no one should be discriminated against because of their differences. All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law. Our rich diversity makes us more innovative, more competitive, and more creative, which helps us better serve our clients and our communities. For details, view a copy of theAccenture Federal Services Equal Opportunity Policy Statement.

Accenture Federal Services is an Equal Employment Opportunity employer. Additionally, as an Aff

Requesting An Accommodation

Accenture Federal Services is committed to providing equal employment opportunities for persons with disabilities or religious observances, including reasonable accommodation when needed. If you are hired by Accenture Federal Services and require accommodation to perform the essential functions of your role, you will be asked to participate in our reasonable accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodations once hired.

If youare being considered for employment opportunities with Accenture Federal Services andneed anaccommodation for a disability or religious observanceduring the interview process or for the job you are interviewing for, please speak with your recruiter.

Other Employment Statements

Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States.

Candidates who are currently employed by a client of Accenture Federal Services or an affiliated Accenture business may not be eligible for consideration.

Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process.

The Company will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. Additionally, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company's legal duty to furnish information.

California requires additional notifications for applicants and employees. If you are a California resident, live in or plan to work from Los Angeles County upon being hired for this position, please click here for additional important information.