Quick Overview
Job Description
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 field
OR - 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.
Similar jobs
- WE
Home Care Coordinator Supervisor
NewAuto ApplyWelbeHealth
Riverside🇺🇸Hybrid9 hours agoCase ManagementComplianceDiversity & Inclusion+3Healthcare - WE
Home Care Supervisor
NewAuto ApplyWelbeHealth
Newark🇺🇸Hybrid13 hours agoComplianceDiversity & InclusionInfection Control+1 - SH
Patient Navigator
NewAuto ApplyStrive Health
Midland🇺🇸Hybrid12 hours agoCRMMental HealthOutreach+3 - SH
Patient Navigator
NewAuto ApplyStrive Health
Lansing🇺🇸Hybrid12 hours agoCRMMental HealthOutreach+3 - SH
Patient Navigator
NewAuto ApplyStrive Health
Grand Rapids🇺🇸Hybrid12 hours agoCRMMental HealthOutreach+3 - SH
Patient Navigator
NewAuto ApplyStrive Health
Bay City🇺🇸Hybrid12 hours agoCRMMental HealthOutreach+3 - SP
Patient Care Coordinator
NewAuto ApplySpecialty1 Partners
North Haven🇺🇸Hybrid14 hours agoTalent AcquisitionInfection ControlPatient Care+1Healthcare - LI
Associate Director, Medical Affairs Operations
NewAuto ApplyLyell Immunopharma
United States🇺🇸$230k - $280k/yrHybrid9 hours agoProject ManagementHealthcare - SH
Medical Coding Manager
NewAuto ApplySprinter Health
Remote - United States🇺🇸Remote14 hours agoOnboardingGoogle WorkspaceCompliance+5Healthcare - BH
Director, Home Health
NewAuto ApplyBAYADA Home Health Care
Londonderry🇺🇸Hybrid7 hours agoRecruitingBudgetingCompliance+4Healthcare - BH
Transitional Care Manager, Home Health
NewAuto ApplyBAYADA Home Health Care
Denver🇺🇸Hybrid13 hours agoMicrosoft OfficeMedical TerminologyHealthcare - TR
Clinical Supervisor
NewAuto ApplyThe Recovery Village
Worcester, Massachusetts🇺🇸On-siteYesterdayMental Health